Orhan Erkan, Özçağlayan Ömer
1 Department of Plastic Surgery, Namik Kemal University, Tekirdağ, Turkey.
2 Department of Radiology, Namik Kemal University, Tekirdağ, Turkey.
Vascular. 2018 Aug;26(4):432-439. doi: 10.1177/1708538118759250. Epub 2018 Feb 12.
Objectives The main factor in the healing of foot ulcers in diabetic patients is adequate perfusion. There is no consensus on whether direct or indirect revascularization is more effective in leg revascularization. At the centre of that debate, there is a disagreement about whether collateral circulation is sufficient or not. Our aim is to evaluate collateral circulation activity between angiosomes in the feet of diabetic patients by evaluating the level of occlusion in leg arteries and comparing the angiosome regions that have necrosis. Methods The study included 61 patients. All had undergone CT angiography to the lower extremity prior to any revascularization of the leg arteries between September 2014 and September 2016. Stenosis was evaluated on the anterior tibial artery, the posterior tibial artery and the peroneal artery up to the level of the ankle. The opening of the vessel wall at the narrowest part of the vessel was determined as a percentage. The areas with necrosis were determined according to the angiosomes of the posterior tibial artery, anterior tibial artery and peroneal artery vessels. Results Necrosis of the foot was most common in the posterior tibial artery angiosome. Necrosis in the posterior tibial artery angiosome was independent of the level of posterior tibial artery occlusion; however, it was associated with the occlusion of the anterior tibial artery ( p < 0.05). It was found that anterior tibial artery occlusion over 15% resulted in necrosis in the posterior tibial artery angiosome. Conclusions Collateral circulation between the anterior tibial artery and posterior tibial artery is active and there is almost always occlusion in the posterior tibial artery branches. The posterior tibial artery angiosome is fed by the collateral arteries of the anterior tibial artery even if there is no occlusion of posterior tibial artery at the level of the leg, so indirect revascularization on the anterior tibial artery is sufficient to provide foot circulation.
目的 糖尿病患者足部溃疡愈合的主要因素是充足的灌注。对于腿部血管重建中直接或间接血管重建哪种更有效，目前尚无共识。在这场争论的核心，是关于侧支循环是否充足存在分歧。我们的目的是通过评估腿部动脉闭塞程度并比较出现坏死的血管体区域，来评估糖尿病患者足部血管体之间的侧支循环活动。方法 该研究纳入了61例患者。所有患者在2014年9月至2016年9月期间，在进行腿部动脉任何血管重建之前均接受了下肢CT血管造影。对胫前动脉、胫后动脉和腓动脉直至踝关节水平的狭窄情况进行评估。将血管最窄处的血管壁开口确定为百分比。根据胫后动脉、胫前动脉和腓动脉血管的血管体确定坏死区域。结果 足部坏死在胫后动脉血管体中最为常见。胫后动脉血管体的坏死与胫后动脉闭塞程度无关；然而，它与胫前动脉闭塞有关（p < 0.05）。发现胫前动脉闭塞超过15%会导致胫后动脉血管体出现坏死。结论 胫前动脉和胫后动脉之间的侧支循环活跃，胫后动脉分支几乎总是存在闭塞。即使在腿部水平胫后动脉没有闭塞，胫后动脉血管体也由胫前动脉的侧支动脉供血，因此对胫前动脉进行间接血管重建足以提供足部循环。
