Direct flow utilizing the angiosome concept is valuable for salvaging limbs in critical limb ischemia patients

Purpose: We sought to determine if direct flow acquired via endovascular therapy (EVT) reduces major adverse limb events (MALE) rates including major amputation (MA), or any re-intervention or death for critical limb ischemia (CLI) patients utilizing the angiosome concept and if it improves skin perfusion pressure (SPP). Method: The 51 consecutive study subjects presented 62 limbs ischemic ulceration (Rutherford 5 or 6) from January 2011 to December 2012 in our institution. We investigated SPP and MALE rates for these CLI patients treated with EVT below the knee. We continued clinical follow-up until January 2013. We classified these patients into 2 groups depending on whether angiosome-based straight lines were obtained or not. Results: There were no significant differences in patient characteristics such as hypertension, dyslipidemia, diabetes mellitus, or hemodialysis between the two groups. There were no significant differences in MALE rates between the two groups. The mean SPP at the plantar after EVT was significantly higher in the direct group (n=34) than in the indirect group (n=28) (50.6, 38.9, respectively, p=0.01). The incidence of major amputations was significantly lower in the direct group than in the indirect group (2.9%, 17.9%, respectively, p=0.04). There were no significant differences in either re-intervention or deaths rates. Conclusion: EVT utilizing the angiosome concept is valuable for improving SPP and salvaging limbs in CLI patients.