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

## TL;DR

Distal bypass surgery improves blood flow across the entire foot in patients with severe leg ischemia, regardless of specific blood vessel areas.

## Contribution

Demonstrates that distal bypass surgery improves skin perfusion pressure in both direct and indirect revascularized angiosomes.

## Key findings

- Skin perfusion pressure improved in both direct and indirect revascularized angiosomes after distal bypass surgery.
- Wound healing rates were higher in direct revascularized angiosomes compared to indirect ones.

## 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.