Journal Article Epublish 1 citation
PubMed: 42278981 DOI: 10.3390/jcm15114119
A Conceptual Wound-Oriented Reinterpretation of Perfusion Heterogeneity in Chronic Limb-Threatening Ischemia.
J Clin Med 15(11)
Authors: Mircea Ionut Popitiu, Lorenzo Patrone, Giacomo Clerici, Serban Comsa, Gloria Gavrila-Ardelean, Nilima Rajpal Kundnani, Nicu Olariu, Mihai Edmond Ionac
Affiliations
- Research Center in Vascular and Endovascular Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
- Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, 50143 Florence, Italy.
- San Carlo Clinic, 20026 Paderno Dugnano, Italy.
- Angiogenesis Research Center, Department II Morphologic Microscopy/Histology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
- Research Center in Vascular and Endovascular Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania. Faculty of Educational Sciences, Psychology and Social Work, "Aurel Vlaicu" University of Arad, 310032 Arad, Romania.
- University Clinic of Internal Medicine and Ambulatory Care, Prevention and Cardiovascular Recovery, Department VI-Cardiology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
- Research Center of Timisoara, Institute of Cardiovascular Diseases, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
- Division of Nephrology, Department of Internal Medicine II, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
- Center for Molecular Research in Nephrology and Vascular Disease, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Abstract
Background/Objectives: The angiosome concept is widely used to guide infrapopliteal revascularization in patients with chronic limb-threatening ischemia (CLTI). However, clinical outcomes are not always fully explained by anatomical target-artery alignment alone. The present study aimed to revisit a previously published angiosome-based cohort through a wound-oriented conceptual perspective and to explore whether perfusion heterogeneity may help contextualize variability in clinical outcomes. Methods: This retrospective secondary analysis included 51 patients with CLTI who underwent infrapopliteal endovascular revascularization. Patients were originally classified as direct, indirect, or mixed revascularization according to angiosome-based criteria. The present study represents an exploratory conceptual reinterpretation of the original dataset. No new variables were introduced, and the woundosome concept was not operationalized as a measurable patient-level variable. Statistical analyses were exploratory and descriptive in nature. Results: High rates of wound healing and limb salvage were observed across all revascularization patterns at 12 months. Within the limitations of this small exploratory cohort, no consistent detectable differences in clinical outcomes were observed across anatomical revascularization patterns. Stratification according to the number of affected angiosomes did not reveal clear outcome differences. The findings suggest that factors beyond anatomical target-artery alignment may contribute to wound healing variability in CLTI. Conclusions: The present study does not establish a validated wound-oriented perfusion model but highlights the limitations of relying exclusively on anatomical angiosome classification when interpreting clinical outcomes in CLTI. In this context, the woundosome may serve as a descriptive and hypothesis-generating conceptual framework for discussing perfusion heterogeneity and wound-level perfusion complexity. Prospective studies integrating objective perfusion assessment and standardized wound evaluation are required.
MeSH
Limb Salvage, Collateral Circulation, Arteries, Ischemia