Abstract: Background: Chronic threatening limb ischemia (CTLI) is a major medical problem affecting limbs, quality of life and survival. Angioplasty is considered as the first choice for treatment. Neither definite strategy was defined as the best option nor intraoperative endpoint for successful angioplasty for infragenicular vessles. Aim: to investigate angiosomal concept and wound blush in wound healing after infra-genicular angioplasty. Methods: 40 patients with CTLI affecting the infra-genicular arteries. Patients were divided into two groups; Direct revascularization (DR) and Indirect Revascularization groups (This was done if the direct revascularization was not technically possible). According to post intervention wound blush, patients were categorized into WB-positive and WB-negative groups. Follow up was done on 1, 3, 6 and 12 months postoperatively.
Results: 60% (24/40) underwent DR, whereas 40% (16/40) underwent IR. ABPI was improved significantly postoperatively. For DR group, 14 (87.5%) patients had their wounds completely epithelialized (P=0.005) and overall limb salvage was 70% (P=0.03). For the IR group, six (54.5%) patients had limb salvage, two (28.57%) had major amputation. From the 40 endovascular interventions, 8 limbs showed positive WB and 32 showed negative WB. Limbs with positive WB healed in a significantly shorter duration (2.82±0.49 months) than did limbs with negative WB (3.2±0.63 months).
Conclusion: DR technique should be the first therapeutic choice for infragenicular angioplasty as it is associated with higher wound healing and limb salvage rates. Presence of wound blush post intervention is a good predictor of wound healing rate and time.