Pilot Assessment of the Angiosome Concept by Intra-operative Fluorescence Angiography After Tibial Bypass Surgery

Journal article


Publication Details

Author(s): Rother U, Lang W, Horch RE, Ludolph I, Meyer A, Gefeller O, Regus S
Journal: European Journal of Vascular and Endovascular Surgery
Publication year: 2018
Volume: 55
Journal issue: 2
Pages range: 215-221
ISSN: 1078-5884


Abstract

OBJECTIVES: The "angiosome" concept as a model for decision making in revascularisation of patients with critical limb ischaemia (CLI) has been subject to lively discussion in recent years. The aim of this prospective pilot study was to use intra-operative fluorescence angiography to provide further data on the angiosome concept on the level of microcirculation after tibial bypass surgery.
DESIGN, MATERIALS, AND METHODS: This was a prospective analysis of 40 patients presenting with CLI Rutherford stage IV to VI before and after tibial bypass surgery. The macrocirculation was measured by the ankle brachial index. Skin microcirculation was assessed by intra-operative fluorescence angiography. The alteration of microcirculation was compared in direct and indirect revascularised angiosomes. Clinical follow-up investigations were performed and the wound healing rate was compared between the different revascularisation methods.
RESULTS: Cumulated microcirculation parameters showed a significant improvement after surgery (ingress, ingress rate p<.001). Likewise, general microcirculatory improvement was observed in each foot angiosome after revascularisation, regardless of the tibial artery revascularised. Furthermore, a comparison of the direct (DR) and the indirect revascularised (IR) angiosomes did not show a significant difference concerning the improvement of microcirculation (difference DR-IR, ingress: 1.69, 95% CI 71.73-75.11; ingress rate: 0.08, 95% CI -12.91 to 13.07). The wound healing rate was similar in both groups, although the time to wound healing was faster by on average 2.5 months in the DR group (p=.083).
CONCLUSION: Microcirculatory improvement was seen over the whole foot after tibial bypass. Therefore, fluorescence angiography is a promising tool to evaluate the angiosome concept in future larger studies. Clinicaltrials.gov: NCT03012750.


FAU Authors / FAU Editors

Gefeller, Olaf Prof. Dr.
Lehrstuhl für Biometrie und Epidemiologie
Horch, Raymund E. Prof. Dr.
Professur für Plastische Chirurgie und Handchirurgie
Lang, Werner apl. Prof. Dr.
Gefäßchirurgische Abteilung
Regus, Susanne PD Dr.
Gefäßchirurgische Abteilung
Rother, Ulrich Dr. med.
Professur für Plastische Chirurgie und Handchirurgie


How to cite

APA:
Rother, U., Lang, W., Horch, R.E., Ludolph, I., Meyer, A., Gefeller, O., & Regus, S. (2018). Pilot Assessment of the Angiosome Concept by Intra-operative Fluorescence Angiography After Tibial Bypass Surgery. European Journal of Vascular and Endovascular Surgery, 55(2), 215-221. https://dx.doi.org/10.1016/j.ejvs.2017.11.024

MLA:
Rother, Ulrich, et al. "Pilot Assessment of the Angiosome Concept by Intra-operative Fluorescence Angiography After Tibial Bypass Surgery." European Journal of Vascular and Endovascular Surgery 55.2 (2018): 215-221.

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Last updated on 2019-04-03 at 12:08