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Evaluation of angiosome based revascularization in diabetic foot ulcers

Sunil Rajendran, Suaib Mohammed Thottiyil, Abid Ali Karatparambil, Mujeeb Rahman Mohammed Nadakkavil, Ranjish Thamaran, Tom Thomas Kattoor.

Abstract
Background: Diabetic foot ulcers are very common complication in diabetic patients and important cause of morbidity to patient and affect quality of life. Ischemia forms a major risk factor for non-healing ulcer. Even after revascularization these ulcers shows delay in healing. Based on studies by Ian Taylor who proposed angiosome concept, it is said that non achievement of direct flow to ulcer area may be a reason for this. Objective of this study was to evaluate the outcome in angiosome based revascularization in diabetic foot ulcer.
Methods: A prospective observational study was done which included 50 diabetic foot ulcer patient who underwent endovascular revascularization in department of general surgery in our hospital during the period October 2013 to March 2015 and they were followed up for 6 months to look for ulcer healing rate , ulcer recurrence , leg salvage rate and major amputation.
Results: Out of 50 participants in 52% direct revascularization was done. Base line characteristics of both the groups were comparable except gender (where proportion of females was higher in indirect group), CKD, smoking, UTCWS grade of ulcer which were more in direct group. Ulcer predominantly affected toes (70%) and Anterior Tibial angiosome was the most common (50%) angiosome involved by clinical classification. Most common affected arterial segment pattern by Peripheral angiogram was multi segmental followed by infra popliteal disease. In 78.3% of cases ulcer healed at 6 months in the indirect group whereas 57.7% patients had healed ulcers at 6 months in the direct group (P value = 0.12). Female gender, CKD, smoking and ulcer grade found to have no association with healing at 6 months. No significant difference was found in leg salvage rate, ulcer recurrence and major amputation.
Conclusions: Endovascular revascularization is a good modality to reduce morbidity in diabetic foot ulcer patients. There was no significant difference in outcome between these two groups.

Key words: Peripheral occlusive arterial disease, Diabetic foot ulcer, Angiosome, Peripheral percutaneous trans luminal angioplasty, Peripheral angiogram



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