Article View – 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

Hostile neck anatomy (HNA) and its variation as a prognostic factor of endovascular aneurysm repair (EVAR) complication in abdominal aortic aneurysm (AAA)

Supatcha Prasertcharoensuk
Department of Surgery, Faculty of Medicine, Khon Kaen University

Wuttinee Sutichaiworapong
Department of Surgery, Faculty of Medicine, Khon Kaen University

Parichart Tanmit
Department of Surgery, Faculty of Medicine, Khon Kaen University

Narongchai Wongkonkitsin
Department of Surgery, Faculty of Medicine, Khon Kaen University

Suppachai Lawanaskol
Medical officer, Chaiprakarn hospital, Chiang Mai, THAILAND

Ploytip Jansiriyotin
Khon Kaen Hospital

Abstract

Background: To determine the factors affecting early type 1A endoleak (T1aEL) in AAA patients receiving conventional EVAR. Methods: This was a prognostic factor study using the PROGRESS II framework. A retrospective cohort design included consecutive cases of AAA. Potential risk factors for T1aEL after EVAR were collected. Results: 19.1% (25/131) of AAA patients receiving conventional EVAR experienced T1aEL. Patients with T1aEL had larger aortic neck diameters, shorter neck lengths, longer operative times, more blood loss, and higher 1-year mortality. Multivariable risk ratio regression revealed that the prognostic factors for early T1aEL were a neck length < 10 mm (mRR 2.68, 95% CI 1.05 – 6.88, p-value = 0.039) and infrarenal angulation > 60 degrees (mRR 1.98, 95% CI 1.08 – 3.63, p-value = 0.027). Conclusion: Patients treated with conventional EVAR who developed T1aEL had a statistically significant increase in 1-year mortality compared to those without T1aEL. The factors contributing to T1aEL include neck length and neck angulation.

Keywords : endovascular aneurysm repair; aortic aneurysm, abdominal; endoleak; perigraft leak.

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