Vascular and Endovascular Review

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VOLUME 6, 2023

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

Novel Scaffolds for the Treatment of Below-the-Knee Peripheral Arterial Disease with Chronic Limb-threatening Ischaemia: A Review

Robert S Zilinyi
Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, US
Marissa Alsaloum
Department of Medicine, New York Presbyterian Hospital, Columbia University Medical Center, New York, US
Aishwarya Raja
Department of Medicine, New York Presbyterian Hospital, Columbia University Medical Center, New York, US
Matthew Finn
Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, US
Sanjum S Sethi
Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, US
Sahil A Parikh
Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, US

Abstract

Below-the-knee (BTK) peripheral arterial disease (PAD) is a significant source of cardiovascular morbidity and mortality. Patients with chronic limbthreatening ischaemia in BTK PAD represent one of the highest-risk cohorts of PAD patients, with little progress having been made regarding long-term patency and mortality over the past four decades. Although conventional balloon angioplasty has long been the standard of care, several novel scaffolds have been introduced over the past decade with promising 1-year patency rates and freedom from clinically driven target limb revascularisation, which may herald a new age of endovascular intervention for BTK PAD. In this review, we present a critical appraisal of the literature surrounding novel scaffolds and drug-eluting technology in the treatment of BTK PAD.

Keywords : Peripheral arterial disease, below the knee, endovascular scaffold, drug eluting technology, endovascular intervention.
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Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.
Mark Yang
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty
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