Impact of angiosomal concept in tibial angioplasty on diabetic foot management and limb survival.

Introduction: The concept of angiosomes plays a crucial role in revascularization strategies for critical limb-threatening
ischemia. Angiosomes are three-dimensional blocks of tissue supplied by specific arteries. Angiosome-directed
revascularization aims to restore blood flow to the ischemic tissue by targeting the specific angiosome affected by the
arterial occlusion.
Aim: This study aims to determine whether to predict better diabetic foot wound healing angiosome or nonangiosome
tibial angioplasty revascularization strategy or the overall wound, ischemia, and foot infection (WIFI) grade of the diabetic
foot.
Patients and Methods: A prospective nonrandomized comparative clinical study was conducted between December
2018 and June 2021 in a single tertiary referral center. The patients signed an institutional approved informed consent,
and the university institutional review board approved the present study.
Results: We performed a total of 100 infrapopliteal endovascular procedures in 110 limbs from 100 consecutive patients.
Patients were divided into two groups according to angiosomal concept, direct group and indirect group. Each group
included 50 patients. There was no significant difference between the two groups, 63.7±6.7 and 64.57±7.2, respectively,
in the direct and indirect groups. There was no significant difference between the two groups regarding the site of the
lesion, the WIFI stage, and the lesion severity scoring system (global limb anatomic staging system) for infrapopliteal
disease analysis. However, there was a significant difference between the two groups regarding the treatment of the
artery with angioplasty. The healing rate in foot lesions among the nonangiosome group and patients with WIFI (II) were
statistically significantly higher than among angiosome group and patients with WIFI (III); 84.6 and 78.2% versus 15.38
and 21.79%, respectively; there was statistical significance difference in the healing rate of foot lesions in the group WIFI
(II) more than WIFI (III) 142 days versus 256 days. There was no statistically significant difference (P>0.05) between
both groups with major amputation, minor amputation, persistent wound, and death. However, there was a significance
difference concerning limb salvage (P=0.045).
Conclusion: Our results coincide with what was published that the limb scoring severity system (WIFI) is more important
than angiosome revascularization in wound healing rate, limb survival rate, and amputation-free survival.