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

Techniques for saphenous ablation, how to choose your strategy

Marie Josee van Rijn
Erasmus Medical Center

Renate van den Bos
Erasmus Medical Center

Abstract

With the enormous amount of treatment techniques available for saphenous ablation, it can be difficult to choose the best strategy. Not only are there different techniques like surgical and endovenous, thermal and non-thermal, and tumescent and non-tumescent, there is also the option to stage treatment, or to perform them in a single combined session. Fortunately, the recent European Society for Vascular Surgery (ESVS) practical guidelines on the treatment of chronic venous disease, provides flowcharts to guide physicians. For the great and small saphenous vein, as well as the anterior accessory saphenous vein, endovenous thermal ablation is the first choice treatment. However, in some cases, a non-thermal non-tumescent technique may be preferred, or even high ligation and stripping if endovenous options are not available. This review gives an overview of the different techniques, compares them and discusses considerations when deciding on treatment strategies.

Keywords : Saphenous ablation, superficial venous reflux, chronic venous disease.

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