{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T08:14:21Z","timestamp":1769847261535,"version":"3.49.0"},"reference-count":48,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Multidisciplinary care with vascular surgery and plastic surgery is essential for lower extremity free flap (LEFF) success in the chronic wound population with diabetes and peripheral vascular disease. There is a lack of understanding on performing targeted direct endovascular reperfusion on a vessel that will be used as the flap recipient. Our study compares outcomes of patients who received targeted revascularization (TR) to the recipient vessel for LEFF anastomosis versus nontargeted revascularization (NR) of arterial recipients prior to LEFF.<\/jats:p><jats:p>LEFF patients who underwent preoperative endovascular revascularization (ER) from July 2011 to January 2023 were reviewed. Location of ER, demographics, perioperative details, and outcomes were collected. TR was performed on the same vessel as the flap recipient and NR was located on a different vessel than the flap recipient.<\/jats:p><jats:p>A total of 55 LEFF patients were identified. Overall, 50.91% (n\u2009=\u200928) received TR and 49.1% (n\u2009=\u200927) received NR. Average age was 60.3\u2009\u00b1\u200910.9 years and average Charlson Comorbidity Index was 5.3\u2009\u00b1\u20091.9. On preoperative angiogram, the TR group had significantly lower rates of ER above the knee (3.6 vs. 33.3%, p\u2009&lt;\u20090.001). Immediate flap success rate was 98.2%, with no differences between groups (p\u2009=\u20091.000). No significant differences were found in rates of any postoperative flap complications (p\u2009=\u20090.898), takeback (p\u2009=\u20090.352), partial flap necrosis (p\u2009=\u20090.648), or dehiscence (p\u2009=\u20090.729). Both TR and NR groups had similar rates of a postoperative angiogram (42.9 vs. 48.2%, p\u2009=\u20090.694) and reintervention (35.7 vs. 40.7% p\u2009=\u20090.701). Amputation rates were similar between TR and NR (17.9 vs. 14.8%, p\u2009=\u20091.000).<\/jats:p><jats:p>Close follow-up with vascular and plastic surgery is required for patients who undergo ER prior to LEFF, as nearly half of our cohort required additional endovascular procedures. Overall, we observed no significant differences in complication rates for the TR and NR groups, informing revascularization strategies for free tissue transfer in a highly comorbid chronic wound population.<\/jats:p>","DOI":"10.1055\/a-2491-3381","type":"journal-article","created":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T19:43:31Z","timestamp":1735328611000},"page":"693-702","source":"Crossref","is-referenced-by-count":4,"title":["A Combined \u201cVasculoplastic\u201d Approach to the Vasculopathic Patient Undergoing Limb Salvage: Understanding the Role of Endovascular Revascularization for Lower Extremity Free Tissue Transfer"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6672-949X","authenticated-orcid":false,"given":"Karen R.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"},{"name":"Georgetown University School of Medicine; Washington, District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0418-5287","authenticated-orcid":false,"given":"Rachel N.","family":"Rohrich","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian X.","family":"Lava","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"},{"name":"Georgetown University School of Medicine; Washington, District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nisha J.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine; Washington, District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecelia M.","family":"Hidalgo","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine; Washington, District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole C.","family":"Episalla","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cameron M.","family":"Akbari","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen K.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of 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ischemia","volume":"47","author":"M Romiti","year":"2008","journal-title":"J Vasc Surg"},{"issue":"03","key":"ref4","first-page":"381","article-title":"Influence of surgical or endovascular distal revascularization of the lower limbs on ischemic ulcer healing","volume":"52","author":"C Varela","year":"2011","journal-title":"J Cardiovasc Surg (Torino)"},{"issue":"02","key":"ref5","first-page":"271","article-title":"Angiosome-guided intervention in critical limb ischemia","volume":"6","author":"M C Bunte","year":"2017","journal-title":"Interv Cardiol Clin"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"706","DOI":"10.3400\/avd.oa.13-00052","article-title":"Combined arterial reconstruction and free tissue transfer for patients with critical limb ischemia","volume":"6","author":"K Igari","year":"2013","journal-title":"Ann Vasc Dis"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.avsg.2020.11.031","article-title":"Indirect endovascular revascularization via collaterals: a new classification to predict wound healing and limb salvage","volume":"73","author":"J C Bekeny","year":"2021","journal-title":"Ann Vasc Surg"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1097\/PRS.0000000000005265","article-title":"The utility of preoperative arteriography for free flap planning in patients with chronic lower extremity wounds","volume":"143","author":"D E Janhofer","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"1316.e7","DOI":"10.1016\/j.avsg.2015.01.035","article-title":"Free tissue transfer after targeted endovascular reperfusion for complex lower extremity reconstruction: setting the stage for success in the presence of mutlivessel disease","volume":"29","author":"M V DeFazio","year":"2015","journal-title":"Ann Vasc 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Black","year":"2020","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"340e","DOI":"10.1097\/PRS.0000000000005851","article-title":"Greater saphenous vein-patch interposition to facilitate flow-sparing microanastomosis of calcified arteries in the distal lower extremity","volume":"144","author":"M V DeFazio","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.1016\/j.jvs.2012.11.112","article-title":"Critical elements to building an effective wound care center","volume":"57","author":"P J Kim","year":"2013","journal-title":"J Vasc Surg"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"M E Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1055\/a-1947-8299","article-title":"Comparison of Charlson Comorbidity Index and modified 5-factor frailty index as clinical risk stratification tools in predicting adverse outcomes in patients undergoing lower extremity free-flap reconstruction","volume":"39","author":"S S Huffman","year":"2023","journal-title":"J Reconstr Microsurg"},{"issue":"07","key":"ref18","doi-asserted-by":"crossref","first-page":"261S","DOI":"10.1097\/01.prs.0000222582.84385.54","article-title":"Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization","volume":"117","author":"C E Attinger","year":"2006","journal-title":"Plast Reconstr Surg"},{"key":"ref19","volume-title":"Percutaneous Transluminal Coronary Angioplasty","author":"T F Malik","year":"2024"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1053\/ejvs.2002.1822","article-title":"Techniques for the endovascular management of complications following lower limb percutaneous transluminal angioplasty","volume":"25","author":"V G Papavassiliou","year":"2003","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1161\/01.CIR.89.1.511","article-title":"Guidelines for peripheral percutaneous transluminal angioplasty of the abdominal aorta and lower extremity vessels. A statement for health professionals from a special writing group of the Councils on Cardiovascular Radiology, Arteriosclerosis, Cardio-Thoracic and Vascular Surgery, Clinical Cardiology, and Epidemiology and Prevention, the American Heart Association","volume":"89","author":"M J Pentecost","year":"1994","journal-title":"Circulation"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1148\/radiology.204.1.9205227","article-title":"Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease","volume":"204","author":"J L Bosch","year":"1997","journal-title":"Radiology"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"1054576","DOI":"10.3389\/fcvm.2022.1054576","article-title":"Endothelial cell dysfunction: implications for the pathogenesis of peripheral artery disease","volume":"9","author":"M M Kavurma","year":"2022","journal-title":"Front Cardiovasc Med"},{"issue":"03","key":"ref24","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1053\/ejvs.1998.0742","article-title":"Peripheral blood flow rates and microvascular responses to orthostatic pressure changes in claudicants before and after revascularisation","volume":"17","author":"M Midttun","year":"1999","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"07","key":"ref25","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.1097\/00006534-199912000-00021","article-title":"The delay phenomenon: the story unfolds","volume":"104","author":"S C Dhar","year":"1999","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref26","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1002\/(SICI)1098-2752(1999)19:4<196::AID-MICR6>3.0.CO;2-5","article-title":"Postoperative changes in blood flow in free muscle flaps: a prospective study","volume":"19","author":"F Lorenzetti","year":"1999","journal-title":"Microsurgery"},{"issue":"09","key":"ref27","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/S0025-6196(12)62692-5","article-title":"Effect of arterial revascularization on transcutaneous oxygen tension of the ischemic extremity","volume":"63","author":"P J Osmundson","year":"1988","journal-title":"Mayo Clin Proc"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1055\/s-2003-38986","article-title":"Limb trauma with arterial injury: long-term performance of venous interposition grafts","volume":"51","author":"B Dorweiler","year":"2003","journal-title":"Thorac Cardiovasc Surg"},{"issue":"03","key":"ref29","first-page":"310","article-title":"Systemic white blood and endothelial cell response after revascularization of critical limb ischemia is only influenced in case of ischemic ulcers","volume":"25","author":"P Danielsson","year":"2006","journal-title":"Int Angiol"},{"issue":"05","key":"ref30","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/j.jvs.2008.06.039","article-title":"Successful lower extremity angioplasty improves brachial artery flow-mediated dilation in patients with peripheral arterial disease","volume":"48","author":"M Husmann","year":"2008","journal-title":"J Vasc Surg"},{"issue":"12","key":"ref31","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.5551\/jat.5181","article-title":"Nitroglycerin-mediated vasodilatation of the brachial artery may predict long-term cardiovascular events irrespective of the presence of atherosclerotic disease","volume":"17","author":"D Akamatsu","year":"2010","journal-title":"J Atheroscler Thromb"},{"issue":"12","key":"ref32","first-page":"1997","article-title":"Relationship between brachial artery flow-mediated dilation and coronary flow reserve in patients with peripheral artery disease","volume":"46","author":"T Pellegrino","year":"2005","journal-title":"J Nucl Med"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/S0741-5214(99)70387-3","article-title":"Detection of distal emboli in patients with peripheral arterial stenosis before and after iliac angioplasty: a prospective study","volume":"29","author":"S Al-Hamali","year":"1999","journal-title":"J Vasc Surg"},{"issue":"03","key":"ref34","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1097\/PRS.0000000000010293","article-title":"Risk-stratified anticoagulation protocol increases success of lower extremity free tissue transfer in the setting of thrombophilia","volume":"152","author":"R Deldar","year":"2023","journal-title":"Plast Reconstr Surg"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"5S","DOI":"10.1016\/j.jvs.2010.01.073","article-title":"Bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial: an intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy","volume":"51","author":"A W Bradbury","year":"2010","journal-title":"J Vasc Surg"},{"issue":"02","key":"ref36","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.jvs.2017.01.024","article-title":"Results for primary bypass versus primary angioplasty\/stent for lower extremity chronic limb-threatening ischemia","volume":"66","author":"J D Darling","year":"2017","journal-title":"J Vasc Surg"},{"issue":"19","key":"ref37","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.1161\/CIRCULATIONAHA.106.621391","article-title":"Endovascular therapies for peripheral arterial disease: an evidence-based review","volume":"116","author":"C J White","year":"2007","journal-title":"Circulation"},{"issue":"03","key":"ref38","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.jvs.2008.04.059","article-title":"Outcomes of endovascular interventions for TASC II B and C femoropopliteal lesions","volume":"48","author":"D T Baril","year":"2008","journal-title":"J Vasc Surg"},{"issue":"03","key":"ref39","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1046\/j.1365-2796.2002.01015.x","article-title":"Extensive use of peripheral angioplasty, particularly infrapopliteal, in the treatment of ischaemic diabetic foot ulcers: clinical results of a multicentric study of 221 consecutive diabetic subjects","volume":"252","author":"E Faglia","year":"2002","journal-title":"J Intern Med"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"327","DOI":"10.2147\/DMSO.S23471","article-title":"Primary infragenicular angioplasty for diabetic neuroischemic foot ulcers following the angiosome distribution: a new paradigm for the vascular interventionist?","volume":"4","author":"V Alexandrescu","year":"2011","journal-title":"Diabetes Metab Syndr Obes"},{"issue":"06","key":"ref41","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/0741-5214(85)90123-5","article-title":"Long-term hemodynamic evaluation of lower extremity percutaneous transluminal angioplasty","volume":"2","author":"P G Borozan","year":"1985","journal-title":"J Vasc Surg"},{"issue":"04","key":"ref42","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1177\/152660280200900403","article-title":"Balloon angioplasty in chronic critical limb ischemia: factors affecting clinical and angiographic outcome","volume":"9","author":"H Balmer","year":"2002","journal-title":"J Endovasc Ther"},{"issue":"01","key":"ref43","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.jvs.2008.02.027","article-title":"Infrapopliteal angioplasty for critical limb ischemia: relation of TransAtlantic InterSociety Consensus class to outcome in 176 limbs","volume":"48","author":"K A Giles","year":"2008","journal-title":"J Vasc Surg"},{"issue":"07","key":"ref44","first-page":"1047","article-title":"Angiographic patency and clinical outcome after balloon-angioplasty for extensive infrapopliteal arterial disease","volume":"76","author":"A Schmidt","year":"2010","journal-title":"Catheter Cardiovasc Interv"},{"issue":"01","key":"ref45","doi-asserted-by":"crossref","first-page":"73","DOI":"10.2147\/vhrm.1.1.73.58932","article-title":"Restenosis after percutaneous angioplasty: the role of vascular inflammation","volume":"1","author":"M Schillinger","year":"2005","journal-title":"Vasc Health Risk Manag"},{"issue":"04","key":"ref46","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1161\/01.CIR.70.4.619","article-title":"Percutaneous transluminal angioplasty of the arteries of the lower limbs: a 5 year follow-up","volume":"70","author":"A Gallino","year":"1984","journal-title":"Circulation"},{"issue":"01","key":"ref47","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1148\/radiol.2251011809","article-title":"Vascular inflammation and percutaneous transluminal angioplasty of the femoropopliteal artery: association with restenosis","volume":"225","author":"M Schillinger","year":"2002","journal-title":"Radiology"},{"issue":"07","key":"ref48","doi-asserted-by":"crossref","first-page":"961","DOI":"10.4239\/wjd.v6.i7.961","article-title":"Peripheral artery disease in patients with diabetes: epidemiology, mechanisms, and outcomes","volume":"6","author":"T Thiruvoipati","year":"2015","journal-title":"World J Diabetes"},{"issue":"31","key":"ref49","doi-asserted-by":"crossref","first-page":"2436","DOI":"10.1093\/eurheartj\/eht149","article-title":"Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I","volume":"34","author":"F Paneni","year":"2013","journal-title":"Eur Heart 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