Vascular and Endovascular Review

VOLUME 6, 2023

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

VOLUME 7, 2024

Developing Advanced Computational Models for Real-Time Monitoring of Vascular Stent Performance

Marta Mendoza
University College London, UK.

Abstract

In silico modelling of medical devices is a very promising strategy for minimizing the requirement for in vitro research and animal testing while boosting device efficiency and cutting development costs. In the current work, in silico models of two commonly used endovascular devices, one interventional and the other implantable, were created. The first device designed was a stentriever for mechanical thrombectomy in the treatment of acute ischaemic stroke. Although stentrievers are routinely utilized in clinics, their true function is not well known. The modelling sought to determine how arterial geometry, thrombus characteristics, and the thrombus' interactions with both the artery wall and the stentriever influence the effectiveness of stentriever thrombectomy. To this goal, we ran finite element simulations of the complete stentriever technique. The modelling included thrombus rupture in order to quantify the risk of embolism. The simulations produce an atlas of failure risk as a function of thrombus composition and artery occlusion site. The modelling findings were then fed into machine learning algorithms to produce a proof-of-concept demonstration of the computational model's use as a real-time patient-specific prediction tool for the likelihood of success of stentriever thrombectomy.

Keywords : Developing Advanced Computational Models (DACM), Real-Time Monitoring (RTM), Vascular Stent Performance (VSP)..
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