Immediate changes of angiosome perfusion during tibial angioplasty

• Published in: Journal of vascular surgery 2017-02, Vol.65 (2), p.422-430
• Main Authors: Rother, Ulrich, MD, Krenz, Katrin, Lang, Werner, MD, Horch, Raymund E., MD, Schmid, Axel, MD, Heinz, Marco, MD, Meyer, Alexander, MD, Regus, Susanne, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angiography, Digital Subtraction; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - methods; Ankle Brachial Index; Blood Flow Velocity; Female; Foot - blood supply; Humans; Laser-Doppler Flowmetry; Magnetic Resonance Angiography; Male; Microcirculation; Middle Aged; Models, Cardiovascular; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - physiopathology; Peripheral Arterial Disease - therapy; Predictive Value of Tests; Prospective Studies; Recovery of Function; Regional Blood Flow; Severity of Illness Index; Skin - blood supply; Spectrum Analysis; Surgery; Tibial Arteries - diagnostic imaging; Tibial Arteries - physiopathology; Time Factors; Treatment Outcome
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2016.08.099

Abstract Objective In recent years, a controversial discussion about the clinical relevance of the angiosome concept during tibial angioplasty has developed. Therefore, we conducted a prospective study to evaluate the angiosome concept on the level of microcirculation during tibial vascular interventions. Methods Thirty patients with isolated tibial angioplasty were examined prospectively. Macrocirculation was evaluated by measurement of the ankle-brachial index (ABI). For the assessment of microcirculation, a combined method of laser Doppler flowmetry and tissue spectrometry (O2C; LEA Medizintechnik GmbH, Giessen, Germany) was applied. Microcirculatory parameters were measured continuously during the procedures. Measuring points were located over different angiosomes of the index foot; a control probe was placed on the contralateral leg. Results Cumulated microcirculation parameters (sO2 , flow) as well as the ABI showed a significant improvement postinterventionally (ABI, P  < .001; sO2 , P  < .001; flow, P  < .001). Assessment of the separate angiosomes of the index leg and the comparison of the directly revascularized (DR) and indirectly revascularized (IR) angiosomes showed no significant difference concerning the microperfusion postinterventionally (DR − IR: sO2 , P  = .399; flow, P  = .909) as well as during angioplasty. Even a further subdivision of the collective into patients with diabetes (sO2 , P  = .445; flow, P  =.758) and renal insufficiency (sO2 , P  = .246; flow, P  = .691) could not demonstrate a superiority of the direct revascularization at the level of microcirculation in these patients (comparison DR − IR). Conclusions There is a significant overall improvement in tissue perfusion of the foot immediately after tibial angioplasty. The effect shown in this study, however, was found to be global and was not restricted to certain borders, such as defined by angiosomes.