Distal Bypass Improves Skin Perfusion Pressure at the Whole Foot Regardless of Angiosomes in Patients with Chronic Limb-Threatening Ischemia

Abstract

Objectives: Distal bypass surgery's effect on tissue blood pressure beyond a focal angiosome remains debated. This study assessed tissue blood pressure in both direct revascularized angiosome (DRA) and indirect revascularized angiosome (IRA) after bypass surgery, utilizing repeated skin perfusion pressure (SPP) measurements. Methods: Twenty-nine limbs in 27 chronic limb-threatening ischemia (CLTI) patients (22 males and five females, age: 70.2 ± 9.3 years) who received distal bypass surgery were enrolled. SPP measurements were conducted for the DRA and IRA at 10 time intervals, encompassing both preoperative and postoperative periods of every 3-5 days until 30 days. Results: In total, 486 SPP measurements were collected from 58 measurement sites, and the transition of the SPP at the DRA was 35.4-62.5-59.5-70.2-58.2-62.2-63.1-63.6-63.8-73.4 mmHg and IRA was 29.4-53.4-53.7-58.8-51.3-63.1-47.9-62.1-57.6-61.0 mmHg. No significant differences were observed between SPP at the DRA and IRA. Fifteen wounds on the DRA (63%) and five on the IRA (100%) healed. Conclusion: Distal bypass improves SPP in both direct and IRAs of CLTI patients. These data indicated distal bypass improves tissue blood flow at entire foot regardless of angiosomes.

Keywords: angiosome; distal bypass; skin perfusion pressure.

Fig. 1 SPP of the direct and IRA. SPP reached > 40 mmHg immediately in the DRA and IRA with a similar time course. Although SPP at the DRA seemed to be superior compared to the IRA, no significant differences were observed between SPP at the direct and indirect revascularized areas except on days 18–20 (p = 0.02). SPP: skin perfusion pressure; IRAs: indirect revascularized angiosomes; DRA: direct revascularized angiosome

Fig. 2 The groups were divided into groups A (n = 13, 45%; SPP peak days occur within 9 days) and group B (n = 16, 55%; peak days occur after 10 days). The SPP transition in each group is shown. Between postoperative 3–9 days, group A had significantly higher SPPs than group B, but the significant differences disappeared after postoperative 10 days. SPP: skin perfusion pressure

Fig. 3 Cumulative incidence curve of wound healing in each group. The wound healing rate in group A was significantly higher (p = 0.01) and wound healing time was significantly shorter (p = 0.04) than those in group B. Details of each group are also shown in Table 2.: Figures are adapted from Distal Bypass Improves Skin Perfusion Pressure at the Entire Foot Regardless of Angiosomes in Patients with Chronic Limb-Threatening Ischaemia, presented at Vascular Annual Meeting 2023 in National Harbor, MD, June 14–17, F. SERIZAWA, with kind permission from ELSEVIER (License Number: 5673890665268)