Effect of Direct or Indirect Revascularization of the Below-The-Knee Lesions on Clinical Outcomes in Patients with Chronic Limb Threatening Ischemia Treated Based on the Angiosome Concept

Ahmet Can Çakmak; Ersan Tatlı; Alper Erkin; Betül Sarıbıyık Çakmak; İbrahim Kocayiğit

doi:10.18521/ktd.1943873

Effect of Direct or Indirect Revascularization of the Below-The-Knee Lesions on Clinical Outcomes in Patients with Chronic Limb Threatening Ischemia Treated Based on the Angiosome Concept

Abstract

Aim: To investigate the impact of direct and indirect revascularization, based on the angiosome concept, on major amputation, minor amputation, and wound healing outcomes after endovascular intervention in patients with critical limb ischemia.

Material and Methods: A total of 121 patients with critical limb ischemia and foot ulcer (Rutherford stage 5–6) were evaluated. During follow-up, 3 patients died, and successful revascularization could not be achieved in 29 patients. The remaining 89 patients were classified according to successful restoration of blood flow to the affected angiosome as direct revascularization (DR, n=59) or indirect revascularization (IR, n=30). Patients were followed for three months for major amputation, minor amputation, and wound healing outcomes.

Results: Among 89 successfully revascularized patients (mean age 63.9 ± 10.2 years, 81.6% male), direct angiosome-targeted flow was achieved in 59 patients (66.3%). During follow-up, the DR group had a significantly lower major amputation rate compared to the IR group (10.2% vs 30%, p=0.018). Minor amputation rates were similar between groups (23.7% vs 23.3%, p=0.967), while wound healing was significantly better in the DR group (61% vs 36.7%, p=0.030).

Conclusion: Angiosome-guided direct revascularization may reduce major amputation risk and improve wound healing in isolated below-knee lesions. Whenever feasible, direct revascularization should be considered the preferred treatment strategy.

Keywords

References

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Details

Primary Language

English

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Ahmet Can Çakmak ^*
0000-0001-5168-8907
Türkiye

Ersan Tatlı
0000-0002-9844-5598
Türkiye

Alper Erkin
0000-0001-6144-3727
Türkiye

Betül Sarıbıyık Çakmak
0000-0002-5379-2254
Türkiye

İbrahim Kocayiğit
0000-0001-8295-9837
Türkiye

Publication Date

June 26, 2026

Submission Date

May 4, 2026

Acceptance Date

June 19, 2026

Published in Issue

Year 2026 Volume: 18 Number: 2

DOI

https://doi.org/10.18521/ktd.1943873

IZ

https://izlik.org/JA63PS97AM

Cite

RIS / Bibtex

APA

Çakmak, A. C., Tatlı, E., Erkin, A., Sarıbıyık Çakmak, B., & Kocayiğit, İ. (2026). Effect of Direct or Indirect Revascularization of the Below-The-Knee Lesions on Clinical Outcomes in Patients with Chronic Limb Threatening Ischemia Treated Based on the Angiosome Concept. Konuralp Medical Journal, 18(2), 163-168. https://doi.org/10.18521/ktd.1943873

AMA

1.Çakmak AC, Tatlı E, Erkin A, Sarıbıyık Çakmak B, Kocayiğit İ. Effect of Direct or Indirect Revascularization of the Below-The-Knee Lesions on Clinical Outcomes in Patients with Chronic Limb Threatening Ischemia Treated Based on the Angiosome Concept. Konuralp Medical Journal. 2026;18(2):163-168. doi:10.18521/ktd.1943873

Chicago

Çakmak, Ahmet Can, Ersan Tatlı, Alper Erkin, Betül Sarıbıyık Çakmak, and İbrahim Kocayiğit. 2026. “Effect of Direct or Indirect Revascularization of the Below-The-Knee Lesions on Clinical Outcomes in Patients With Chronic Limb Threatening Ischemia Treated Based on the Angiosome Concept”. Konuralp Medical Journal 18 (2): 163-68. https://doi.org/10.18521/ktd.1943873.

EndNote

Çakmak AC, Tatlı E, Erkin A, Sarıbıyık Çakmak B, Kocayiğit İ (June 1, 2026) Effect of Direct or Indirect Revascularization of the Below-The-Knee Lesions on Clinical Outcomes in Patients with Chronic Limb Threatening Ischemia Treated Based on the Angiosome Concept. Konuralp Medical Journal 18 2 163–168.

IEEE

[1]A. C. Çakmak, E. Tatlı, A. Erkin, B. Sarıbıyık Çakmak, and İ. Kocayiğit, “Effect of Direct or Indirect Revascularization of the Below-The-Knee Lesions on Clinical Outcomes in Patients with Chronic Limb Threatening Ischemia Treated Based on the Angiosome Concept”, Konuralp Medical Journal, vol. 18, no. 2, pp. 163–168, June 2026, doi: 10.18521/ktd.1943873.

ISNAD

Çakmak, Ahmet Can - Tatlı, Ersan - Erkin, Alper - Sarıbıyık Çakmak, Betül - Kocayiğit, İbrahim. “Effect of Direct or Indirect Revascularization of the Below-The-Knee Lesions on Clinical Outcomes in Patients With Chronic Limb Threatening Ischemia Treated Based on the Angiosome Concept”. Konuralp Medical Journal 18/2 (June 1, 2026): 163-168. https://doi.org/10.18521/ktd.1943873.

JAMA

1.Çakmak AC, Tatlı E, Erkin A, Sarıbıyık Çakmak B, Kocayiğit İ. Effect of Direct or Indirect Revascularization of the Below-The-Knee Lesions on Clinical Outcomes in Patients with Chronic Limb Threatening Ischemia Treated Based on the Angiosome Concept. Konuralp Medical Journal. 2026;18:163–168.

MLA

Çakmak, Ahmet Can, et al. “Effect of Direct or Indirect Revascularization of the Below-The-Knee Lesions on Clinical Outcomes in Patients With Chronic Limb Threatening Ischemia Treated Based on the Angiosome Concept”. Konuralp Medical Journal, vol. 18, no. 2, June 2026, pp. 163-8, doi:10.18521/ktd.1943873.

Vancouver

1.Ahmet Can Çakmak, Ersan Tatlı, Alper Erkin, Betül Sarıbıyık Çakmak, İbrahim Kocayiğit. Effect of Direct or Indirect Revascularization of the Below-The-Knee Lesions on Clinical Outcomes in Patients with Chronic Limb Threatening Ischemia Treated Based on the Angiosome Concept. Konuralp Medical Journal. 2026 Jun. 1;18(2):163-8. doi:10.18521/ktd.1943873