Swipe om te navigeren naar een ander artikel
The online version of this article (doi:10.1186/s13047-017-0206-5) contains supplementary material, which is available to authorized users.
Ischaemic ulcerations have been reported to persist and/or deteriorate despite technically successful revascularisations; a higher incidence of which affects patients with diabetes and critical limb ischaemia. In the context of wound healing, it is unclear if applications of the angiosome concept in ‘direct revascularisation’ (DR) would be able to aid the healing of chronic foot ulcerations better than the current ‘best vessel’ or ‘indirect revascularisation’ (IR) strategy in patients with co-morbid diabetes and critical limb ischaemia.
A literature search was conducted in eight electronic databases, namely AMED, CINAHL, The Cochrane Library, ProQuest Health & Medicine Complete, ProQuest Nursing & Allied Health Source, PubMed, ScienceDirect and TRIP database. Articles were initially screened against a pre-established inclusion and exclusion criteria to determine eligibility and subsequently appraised using the Newcastle-Ottawa Scale.
Five retrospective studies of varying methodological quality were eligible for inclusion in this review. Critical analysis of an aggregated population (n = 280) from methodologically stronger studies indicates better wound healing outcomes in subjects who had undergone DR as compared to IR (p < 0.001; p = 0.04). DR also appears to result in a nearly twofold increase in probability of wound healing within 12 months (hazard ratio, 1.97; 95% CI, 1.34–2.90). This suggests that achieving direct arterial perfusion to the site of ulceration may be important for the healing of chronic diabetic foot ulcerations.
Incorporating an angiosome-directed approach in the lower limb revascularisation strategy could be a very useful adjunct to a solely indirect approach, which could increase the likelihood of wound healing. With the limited data currently available, findings appear promising and merit from further investigation. Additional research to form a solid evidence base for this revised strategy in patients with co-morbid diabetes and critical limb ischaemia is warranted.
Additional file 1: Database Search Record. (DOCX 17 kb)13047_2017_206_MOESM1_ESM.docx
Additional file 2: Only Abstracts Accessible. (DOCX 19 kb)13047_2017_206_MOESM2_ESM.docx
Additional file 3: Full-text Articles Excluded. (DOCX 21 kb)13047_2017_206_MOESM3_ESM.docx
Additional file 4: Literature Review Tables. (DOCX 34 kb)13047_2017_206_MOESM4_ESM.docx
Additional file 5: The Newcastle-Ottawa Scale (NOS) scores. (DOCX 20 kb)13047_2017_206_MOESM5_ESM.docx
Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vas Surg. 2007;45(1):S5–S67. Available from: doi: 10.1016/j.jvs.2006.12.037. Accessed 21 Oct 2015.
Game FL, Apelqvist J, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M, et al. IWGDF guidance on use of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2015;32(Suppl S1):75–83. Available from: doi: 10.1002/dmrr.2700. Accessed 13 Jan 2016.
Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, et al. An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries: A Supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Endovasc Ther. 2015;22(5):663–77. Available from: doi: 10.1177/1526602815592206. Accessed 13 Nov 2015.
Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366(9501):1925–34. Available from: doi: 10.1016/S0140-6736(05)67704-5. Accessed 11 Oct 2015. CrossRefPubMed
Baerlocher MO, Kennedy SA, Rajebi MR, Baerlocher FJ, Misra S, Liu D, et al. Meta-analysis of drug-eluting balloon angioplasty and drug-eluting stent placement for infrainguinal peripheral arterial disease. J Vasc Interv Radiol. 2015;26(4):459–473.e4. Available from: doi: 10.1016/j.jvir.2014.12.013. Accessed 9 Feb 2016. CrossRefPubMed
Conte MS, Geraghty PJ, Bradbury AW, Hevelone ND, Lipsitz SR, Moneta GL, et al. Suggested objective performance goals and clinical trial design for evaluating catheter-based treatment of critical limb ischemia. J Vasc Surg. 2009;50(6):1462–1473.e3. Available from: doi: 10.1016/j.jvs.2009.09.044. Accessed 5 Nov 2015. CrossRefPubMed
Kumar A, Brooks SS, Cavanaugh K, Zuckerman B. FDA perspective on objective performance goals and clinical trial design for evaluating catheter-based treatment of critical limb ischemia. J Vasc Surg. 2009;50(6):1474–6. Available from: doi: 10.1016/j.jvs.2009.09.045. Accessed 5 Nov 2015.
Carsten CG 3rd, Taylor SM, Langan EM 3rd, Crane MM. Factors associated with limb loss despite a patent infrainguinal bypass graft. Am J Surg. 1998;64(1):33–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9457035. Accessed 4 Jan 2016.
Attinger CE, Evans KK, Mesbahi A. Angiosomes of the foot and angiosome-dependent healing. In: Sidawy AN, editor. Diabetic foot: Lower extremity arterial disease and limb salvage. Philadelphia: Lippincott Williams and Wilkins; 2006. p. 75–107.
Simons JP, Goodney PP, Nolan BW, Cronenwett JL, Messina LM, Schanzer A. Failure to achieve clinical improvement despite graft patency in patients undergoing infrainguinal lower extremity bypass for critical limb ischemia. J Vasc Surg. 2010;51(6):1419–24. Available from: doi: 10.1016/j.jvs.2010.01.083. Accessed 19 Jan 2016. CrossRefPubMedPubMedCentral
Forsythe RO, Jones KG, Hinchliffe RJ. Distal bypasses in patients with diabetes and infrapopliteal disease: technical considerations to achieve success. Int J Low Extrem Wounds. 2014;13(4):347–62. Available from: doi: 10.1177/1534734614546951. Accessed 12 Dec 2015.
COOK MEDICAL, 2017. Cook Medical/Khor Images and Authorization [email image]. Khor, B.Y.C. Amer.Fulfillment@CookMedical.com. 2017. Permission for use granted by Cook Medical, Bloomington, Indiana.
Attinger CE, Evans KK, Bulan E, Blume P, Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg. 2006;117(Suppl 7):261S–93S. Available from: doi: 10.1097/01.prs.0000222582.84385.54. Accessed 2 Jan 2016. CrossRefPubMed
Alexandrescu V. The angiosome concept: anatomical background and physiopathological landmarks in CLI. In: Alexandrescu V, editor. Angiosomes applications in critical limb ischaemia–in search for relevance. Italy: Edizioni Minerva Medica; 2013. Available from: http://www.minervamedica.it/en/preview.php?pdf=L1956. Accessed 7 Jan 2016.
Bosanquet DC, Glasbey JC, Williams IM, Twine CP. Systematic review and meta-analysis of direct versus indirect angiosomal revascularisation of infrapopliteal arteries. Eur J Vasc Endovasc Surg. 2014;48(1):88–97. Available from: doi: 10.1016/j.ejvs.2014.04.002. Accessed 2 Jan 2016.
All-Party Parliamentary Group on Vascular Disease (APPG). Saving limbs, saving lives: a review of strategic clinical networks . APPG; 2015. Available from: http://appgvascular.org.uk/media/reports/2015-12-saving_limbs_saving_lives___a_review_of_strategic_clinical_networks.pdf. Accessed 23 Dec 2015.
International Diabetes Federation (IDF), International Working Group on the Diabetic Foot (IWGDF). Time to act. 2015 . Available from: https://www.worlddiabetesfoundation.org/sites/default/files/Diabetes%20and%20Foot%20care_Time%20to%20act.pdf. Accessed 23 Dec 2015.
Hinchliffe RJ, Andros G, Apelqvist J, Bakker K, Friederichs S, Lammer J, et al. A systematic review of the effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease. Diabetes Metab Res Rev. 2012;28(Suppl 1):179–217. Available from: doi: 10.1002/dmrr.2249. Accessed 24 Jan 2016. CrossRefPubMed
Critical Appraisal Skills Programme (CASP). CASP Checklists . Available from: http://www.casp-uk.net/#!checklists/cb36. Accessed 17 Jan 2016.
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 17 Jan 2016.
Scottish Intercollegiate Guidelines Network (SIGN). Critical Appraisal: Notes and Checklists. Available from: http://www.sign.ac.uk/checklists-and-notes.html. Accessed 17 Jan 2016.
Reeves BC, Deeks JJ, Higgins JPT, Wells GA. Including non-randomized studies. In: JPT H, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. 5.1.0 ed. United Kingdom: The Cochrane Collaboration; 2011. Available from: http://handbook.cochrane.org. Accessed 3 Dec 2015.
Zeng X, Zhang Y, Kwong JS, Zhang C, Li S, Sun F. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med. 2015;8(1):2–10. Available from: doi: 10.1111/jebm.12141. Accessed 17 Jan 2016. CrossRefPubMed
Jeffcoate WJ, Bus SA, Game FL, Hinchliffe RJ, Price PE, Schaper NC. Reporting standards of studies and papers on the prevention and management of foot ulcers in diabetes: required details and markers of good quality. Lancet Diabetes Endocrinol. 2016;4(9):781–8. Available from: doi: 10.1016/S2213-8587(16)30012-2. Accessed 18 Aug 2016. CrossRefPubMed
Fossaceca R, Guzzardi G, Cerini P, Cusaro C, Stecco A, Parziale G, et al. Endovascular treatment of diabetic foot in a selected population of patients with below-the-knee disease: is the angiosome model effective? Cardiovasc Intervent Radiol. 2013;36(3):637–44. Available from: doi: 10.1007/s00270-012-0544-4. Accessed 4 Jan 2016. CrossRefPubMed
Söderström M, Albäck A, Biancari F, Lappalainen K, Lepäntalo M, Venermo M. Angiosome-targeted infrapopliteal endovascular revascularization for treatment of diabetic foot ulcers. J Vasc Surg. 2013;57(2):427–35. Available from: doi: 10.1016/j.jvs.2012.07.057. Accessed 2 Jan 2016. CrossRefPubMed
Acín F, Varela C, de Maturana IL, de Haro J, Bleda S, Rodriguez-Padilla J. Results of infrapopliteal endovascular procedures performed in diabetic patients with critical limb ischemia and tissue loss from the perspective of an angiosome-oriented revascularization strategy. Int J Vasc Med. 2014;2014(2014):1–13. Available from: doi: 10.1155/2014/270539. Accessed 4 Jan 2016.
Lejay A, Georg Y, Tartaglia E, Gaertner S, Geny B, Thaveau F, et al. Long-term outcomes of direct and indirect below-the-knee open revascularization based on the angiosome concept in diabetic patients with critical limb ischemia. Ann Vasc Surg. 2014;28(4):983–9. Available from: doi: 10.1016/j.avsg.2013.08.026. Accessed 2 Jan 2016. CrossRefPubMed
Jeon EY, Cho YK, Yoon DY, Kim DJ, Woo JJ. Clinical outcome of angiosome-oriented infrapopliteal percutaneous transluminal angioplasty for isolated infrapopliteal lesions in patients with critical limb ischemia. Diagn Interv Radiol. 2016;22(1):52–8. Available from: doi: 10.5152/dir.2015.15129. Accessed 27 Aug 2016.
International Working Group on the Diabetic Foot (IWGDF). Definitions and criteria . IWGDF; 2015. Available from: http://www.iwgdf.org/files/2015/website_definitions.pdf. Accessed 6 Sept 2016.
Escobedo J, Rana JS, Lombardero MS, Albert SG, Davis AM, Kennedy FP, et al. Association Between Albuminuria and Duration of Diabetes and Myocardial Dysfunction and Peripheral Arterial Disease Among Patients With Stable Coronary Artery Disease in the BARI 2D Study. Mayo Clin Proc. 2010;85(1):41–6. Available from: doi: 10.4065/mcp.2009.0265. Accessed 31 Jan 2016. CrossRefPubMedPubMedCentral
Lip GY, Barnett AH, Bradbury A, Cappuccio FP, Gill PS, Hughes E, et al. Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management. J Hum Hypertens. 2007;21(3):183–211. Available from: doi: 10.1038/sj.jhh.1002126. Accessed 6 Sept 2016. CrossRefPubMed
Aboyans V, Desormais I, Lacroix P, Salazar J, Criqui MH, Laskar M. The general prognosis of patients with peripheral arterial disease differs according to the disease localization. J Am Coll Cardiol. 2010;55(9):898–903. Available from: doi: 10.1016/j.jacc.2009.09.055. Accessed 27 Jan 2016. CrossRefPubMed
National Institute for Health and Care Excellence (NICE). Diabetic foot problems: prevention and management. NICE; 2015. Available from: nice.org.uk/guidance/ng19. Accessed 5 Jan 2016.
Gottrup F, Apelqvist J, Price P. Outcomes in controlled and comparative studies on non-healing wounds: recommendations to improve the quality of evidence in wound management. J Wound Care. 2010;19(6):237–68. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20551864. Accessed 3 Feb 2016.
Dubský M, Jirkovská A, Bem R, Fejfarová V, Skibová J, Schaper NC, et al. Risk factors for recurrence of diabetic foot ulcers: prospective follow-up analysis in the Eurodiale subgroup. Int Wound J. 2013;10(5):555–61. Available from: doi: 10.1111/j.1742-481X.2012.01022.x. Accessed 7 Feb 2016. CrossRefPubMed
Monteiro-Soares M, Boyko EJ, Ribeiro J, Ribeiro I, Dinis-Ribeiro M. Predictive factors for diabetic foot ulceration: a systematic review. Diabetes Metab Res Rev. 2012;28(7):574–600. Available from: doi: 10.1002/dmrr.2319. Accessed 22 Jan 2016.
Velengtas P, Mohr P, Messner DA. Making informed decisions: Assessing the strengths and weaknesses of study designs and analytic methods for comparative effectiveness research: A briefing document for stakeholders . National Pharmaceutical Council. 2012. Available from: http://www.npcnow.org/system/files/research/download/experimental_nonexperimental_study_final.pdf. Accessed 28 Jan 2016.
World Health Organisation (WHO), International Diabetes Federation (IDF). The Saint Vincent Declaration. Acta Ophthalmol. 1999;75(S223):63. Available from: doi: 10.1111/j.1600-0420.1997.tb00440.x. Accessed 13 June 2017.
Lida O, Takahara M, Soga Y, Yamauchi Y, Hirano K, Tazaki J, et al. Worse limb prognosis for indirect versus direct endovascular revascularization only in patients with critical limb ischemia complicated with wound infection and diabetes mellitus. Eur J Vasc Endovasc Surg. 2013;46(5):575–82. Available from: doi: 10.1016/j.ejvs.2013.08.002. Accessed 2 Jan 2016. CrossRef
Zheng XT, Zeng RC, Huang JY, Pan LM, Su X, Wu ZH, et al. The Use of the Angiosome Concept for Treating Infrapopliteal Critical Limb Ischemia through Interventional Therapy and Determining the Clinical Significance of Collateral Vessels. Ann Vasc Surg. 2016;32:41–9. Available from: doi: 10.1016/j.avsg.2015.09.021. Accessed 29 Oct 2016. CrossRefPubMed
Azuma N, Uchida H, Kokubo T, Koya A, Akasaka N, Sasajima T. Factors Influencing Wound Healing of Critical Ischaemic Foot after Bypass Surgery: Is the Angiosome Important in Selecting Bypass Target Artery ? Eur J Vasc Endovasc Surg. 2012;43(3):322–8. Available from: doi: 10.1016/j.ejvs.2011.12.001. Accessed 2 Jan 2016. CrossRefPubMed
Kret MR, Cheng D, Azarbal AF, Mitchell EL, Liem TK, Moneta GL, et al. Utility of direct angiosome revascularization and runoff scores in predicting outcomes in patients undergoing revascularization for critical limb ischemia. J Vasc Surg. 2014;59(1):121–8. Available from: doi: 10.1016/j.jvs.2013.06.075. Accessed 2 Jan 2016. CrossRefPubMed
Pavé M, Benadiba L, Berger L, Gouicem D, Hendricks M, Plissonnier D. Below-The-Knee Angioplasty for Critical Limb Ischemia: Results of a Series of 157 Procedures and Impact of the Angiosome Concept. Ann Vasc Surg. 2016;36:199–207. Available from: doi: 10.1016/j.avsg.2016.03.032. Accessed 24 Jan 2017. CrossRefPubMed
Hatch DC, Armstrong DG. The Multidisciplinary Team Approach To The Diabetic Foot. Podiatry Today . 2016;29(6). Available from: http://www.podiatrytoday.com/multidisciplinary-team-approach-diabetic-foot. Accessed 17 Sept 2016.
University of Birmingham (UoB). BASIL-2 Trial. Available from: http://www.birmingham.ac.uk/Documents/college-mds/trials/bctu/Basil-%2D-2/Investigators/Documentation/BASIL2Protocolv2.pdf. Accessed 23 Jan 2016.
Hunt BD, Popplewell MA, Davies H, Meecham L, Jarrett H, Bate G, et al. BAlloon versus Stenting in severe Ischaemia of the Leg-3 (BASIL-3): study protocol for a randomised controlled trial. Trials. 2017;18(224):1–9. Available at: doi: 10.1186/s13063-017-1968-6. Accessed 13 June 2017.
New England Research Institute. Best Endovascular versus Best Surgical Therapy in patients with CLI (BEST-CLI) trial [NCT02060630]. Available from: https://clinicaltrials.gov/ct2/show/NCT02060630?term=best+cli&rank=1. Accessed 23 Jan 2016.
Price P, Gottrup F, Abel M. Ewma Study Recommendations: For Clinical Investigations in Leg Ulcers and Wound Care. J Wound Care. 2013;23(5):S1–S36. Available from: http://ewma.org/fileadmin/user_upload/EWMA.org/Project_Portfolio/EWMA_Documents/EWMA_StudyRecommendations_FINAL_SELFPRINT.pdf. Accessed 9 Feb 2016.
Boulton AJM, Armstrong DG. The Diabetic Foot. In: Fonseca VA, editor. Clinical Diabetes: Translating Research into Practice. Philadelphia: Saunders Elsevier; 2006. p. 179–95. Available from: http://www.sciencedirect.com/science/book/9781416002734#ancsection2. Accessed 8 Nov 2015. CrossRef
Graziani L, Silvestro A, Bertone V, Manara E, Andreini R, Sigala A, et al. Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorisation of disease severity. Eur J Vasc Endovasc Surg. 2007;33(4):453–60. Available from: doi: 10.1016/j.ejvs.2006.11.022. Accessed 19 Jan 2016. CrossRefPubMed
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309–32. Available from: doi: 10.1016/j.ajic.2008.03.002. Accessed 4 Feb 2016.
Hingorani A, LaMuraglia GM, Henke P, Meissner MH, Loretz L, Zinszer KM, et al. The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016;63(2):3S–21S. Available from: doi: 10.1016/j.jvs.2015.10.003. Accessed 12 Feb 2016. CrossRefPubMed
All-Party Parliamentary Group on Vascular Disease (APPG). Saving Limbs, Saving Lives: Patient Access to Technologies for the Diagnosis and Treatment of Peripheral Arterial Disease. APPG; 2016. Available from: http://appgvascular.org.uk/media/reports/2016-12-saving_limbs__saving_lives__patient_access_to_technologies_for_the_diagnosis_and_treatment_of_peripheral_arterial_disease.pdf. Accessed 1 Feb 2017.
- The comparative efficacy of angiosome-directed and indirect revascularisation strategies to aid healing of chronic foot wounds in patients with co-morbid diabetes mellitus and critical limb ischaemia: a literature review
Benedictine Y. C. Khor
- BioMed Central