Direct versus indirect revascularization in the treatment of ischemic heel: A prospective comparative study

Aborahma, Amr M.; Elbarbary, Ahmed H.; Mokhtar, Hosam M.; Kamhawy, Adel H.

doi:10.4103/ejs.ejs_185_22

Direct versus indirect revascularization in the treatment of ischemic heel: A prospective comparative study

Authors

Abstract

Objective
Ischemic heel ulcers are widely considered to be extremely difficult to treat and often end up with major amputation. Direct revascularization (DR) of the heel through dilatation of the posterior tibial artery (PTA) is presumed to be superior to indirect revascularization.
Patients and methods
This prospective study included 42 limbs in 42 patients having ischemic heel ulcers or heel gangrene due to isolated below-the-knee arterial lesions. Patients with ischemia due to above-the-knee occlusive disease were excluded from the study. Non-reconstructable vascular lesions with no distal run-off and cases with failed revascularization during endovascular intervention were early excluded from the study. The patients were divided, according to whether the PTA was successfully revascularized or not, into group I (direct heel revascularization) and group II (indirect heel revascularization).
Results
A total of 22 (52.38%) patients were included in group I compared with 20 (47.62%) patients in group II. Overall, 32 (76.19%) limbs were salvaged during the study period: 17 in group I and 15 in group II. There was no statistically significant difference in overall limb salvage between both groups (=0.826). The ulcer healing time was shorter in group I, which was statistically significant (=0.002). Complete ulcer healing was observed in 16 patients in group I and 10 patients in group II (=0.039).
Conclusion
DR of heel ulcers through PTA revascularization is associated with higher wound healing rates. In case where DR is not technically feasible, indirect revascularization is an alternative with nearly equivalent rates of limb salvage.

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