Feasibility Of Direct Angiosome Revascularization In Patient With Foot Wounds
Bradley N. Trinidad, Woei Tan, kaoru Goshima, Naren Patel, Allison Rottman, craig Weinkauf, Jennifer Palpalardo, Wei Zhou.
University of Arizona, Tucson, AZ, USA.
OBJECTIVES: Direct angiosome revascularization has been shown to improve wound healing. However, direct revascularization is not always feasible. A clinical pathology of orphan heel syndrome with a triad of posterior tibial and peroneal artery occlusive disease, poorly controlled diabetes, and renal failure poses significant challenges for limb preservation. This pathology is frequently manifested by non-healing heel wound and relatively normal ankle-branchial index on tradition duplex evaluations. The purpose of this study is to examine the frequency of orphan heel syndrome among Hispanic and Native American populations, and the feasibility of direct angiosome revascularization in patients present with ischemic foot wound. METHODS: A retrospective review of clinical data from 7/2017 to 5/2020 at a single academic institution was conducted. Only those who presented with ischemic foot wounds and underwent an angiographic examination were included, those required prompt amputation secondary to infection were excluded from the study. Wound location and potential for direct angiosome revascularization were evaluated. Descriptive analysis using Stata 14.2 were performed. RESULTS: A total of 112 patients including 22 Native Americans, 53 Hispanics, and 37 Caucasians who met inclusion criteria were include in the analysis. The mean age was 67 years (range, 43 to 94 years). Angiosome-directed therapy was considered feasible in 42% of Native Americans, 48% of Hispanics, and 66% of Caucasians (P=0.017). Among them, 16 patients had heel wounds. Of those, 55% of Hispanics were not amendable to direct angiosome revascularization, compared with 33% of Native Americans and 25% of Caucasians, respectively. CONCLUSIONS:This study shows that Hispanics and Native American populations had lower feasibility for direct angiosome revascularization compared to their Caucasian counterpart. This distinct feature in arterial distribution related to pathophysiological disease process may contribute to the disparity in clinical outcomes among Hispanic and Native American patients with ischemic foot ulcers.
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