The role of foot collateral blood supply in the healing of ischemic wounds and limb salvage in patients with critical lower limb ischemia
A retrospective evaluation of 192 endovascular interventions in patients with ischemic wounds, which were performed from November 2006 to March 2011. In accordance with the type of revascularization performed, patients were divided into the three groups. Direct revascularization (DR - the restoration of blood flow by the artery directly supplying the injured angiosome) was performed in 84 cases, indirect revascularization through the collateral vessel (IRC - the restoration of blood flow by the artery feeding the injured angiosome through the collateral vessel) - in 54 observations and indirect revascularization (IR - the restoration of blood supply to the foot in the absence of visible collateral vessels to the ischemic angiosome) - in 54 cases. Percentage of unhealed ulcers in DR, IRC and IR groups was 9%, 19% and 61% at 6 months and 2%, 4% and 27% at 12 months after ER, respectively. There were no statistical difference in healing time between DR and IRC groups (p=0,24). The healing process in patients of IR group was significantly longer, compared with DR and IRC groups (p<0,0001 in both cases). Limb salvage in DR, IRC, and IR groups was 99%, 100% and 90% at 6 months, 96%, 95% and 76% at 12 months and 96%, 90% and 64% at 3 years after ER, respectively. Limb salvage in IR group was significantly lower than in DR and IRC groups (p=0,01 when compared with DR group, p=0,03 when compared with IRC group), in which this parameter was not significantly different (p=0,65). Conclusions: Restoration of blood flow to the injured angiosome when ER is performed in patients with CLI significantly reduces healing time of ischemic ulcers of the foot and leads to a reduction of major amputation frequency. The results of IRC are not significantly different from the results of DR.