Target Artery Pathway Is a Fundamental Option for Limb Salvage, Hypothesis or Fact?

Objectives: Critical limb ischemia rate is rapidly increasing. Target artery pathway delineates how tissue fed by specific direct arterial flow can tremendously affect wound healing and limb salvage. This term was described to provide new information that can be applicable for improving revascularization of ischemic tissue lesions. The concept allows deliberate arterial reconstruction with certain priorities in specific ischemic areas in which target artery pathway is certain rescue vessel. Methods: Target artery pathway reperfusion has been used as the first option plan in all critical limb ischemia cases classified as Rutherford V and VI from January 2019 to June 2019; all data were identified and collected. Target artery reperfusion has been used in 30 patients with 35 critical limbs in 6 months. Nondiabetics and end-stage renal disease patients were excluded. All included cases evaluated by Duplex scan confirming target artery pathway lesions. Computed tomographic angiography was done in selected cases when proximal lesion was suspected. All cases were treated by plain balloon angioplasty. Results: Target artery pathway revascularization success rate was 68.5% (24 limbs out of 35). Using both antegrade and/or retrograde angioplasty, special cases with poor runoff hybrid retrograde metatarsal angioplasty technique was used. Failure of target artery pathway was in 31.4% (11 cases out of 35). Two cases ended with major amputation. Conclusion: Target artery pathway may contribute to a shift in common reperfusion theories. However, collective data still are debatable as there is no strong evidence for angiosomal theories. The evidence is scarce depending on the severity of the target artery pathway disease. Target artery pathway with direct pulsatile flow to the affected tissue is postulated to be valid, especially in diabetics, whose ischemic lesions tend to heal worse than those of nondiabetics.

 

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Publication History

Article published online:
26 April 2021