***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess 3- and 12-month angiographic restenosis rates and their clinical impact after  infrapopliteal angioplasty .  DESIGN Prospect i ve multicenter study . MATERIAL S AND METHODS We analyzed 68 critical ischemic limbs ( tissue loss : 58 limbs ) from 63 consecutive patients due to isolated infrapopliteal lesions who underwent angioplasty alone .  Primary endpoint was 3-month angiographic restenosis rate ; secondary endpoints were 12-month angiographic restenosis rate , and 3- and 12-month rates of mortality , major amputation and reintervention . Three- and 12-month frequency of ambulatory status and of freedom from ischemic symptoms , and time to wound healing in the ischemic wound group , were compared between restenotic and non-restenotic groups . Angiographic restenosis predictors were assessed by multivariable analysis . RESULTS 95 % of cases had 3-month angiography ; restenosis rate was 73 % : 40 % restenosis and 33 % re-occlusion . Twelve-month follow-up angiography was conducted for the patients without 3-month angiographic restenosis , and restenosis rate at 12 months was 82 % . Non-administration of cilostazol and statin , and chronic total occlusion were 3-month angiographic restenosis predictors . Three- and 12-month mortality was 5 % and 12 % , respectively . Despite no patients having undergone amputation , 15 % had persistent ischemic symptoms , and 48 % of limbs underwent reintervention within 12 months . During the same study period , ambulatory status and limbs with complete healing were more frequently observed in the non-restenosis group than in the restenosis group . In the tissue loss group , time to wound healing in the restenosis group was longer than in the non-restenosis group ( 127 days vs. 66 days , p = 0.02 ) . CONCLUSION The extremely high angiographic restenosis rate after infrapopliteal angioplasty may adversely impact clinical status improvement Introduction : Recently , endovascular revascularization ( percutaneous transluminal angioplasty [ PTA ] ) has challenged surgery as a method for the salvage of  critically ischemic legs ( CLI ) . Comparison of surgical and endovascular techniques in r and omized controlled trials is difficult because of differences in patient characteristics . To overcome this problem , we adjusted the differences by using propensity score analysis . Material s and Methods : The study cohort comprised 1023 patients treated for CLI with 262 endovascular and 761 surgical revascularization procedures to their crural or pedal arteries . A propensity score was used for adjustment in multivariable analysis , for stratification , and for one-to-one matching . Results : In the overall series , PTA and bypass surgery achieved similar 5-year leg salvage ( 75.3 % vs 76.0 % ) , survival ( 47.5 % vs 43.3 % ) , and amputation-free survival ( 37.7 % vs 37.3 % ) rates and similar freedom from any further revascularization ( 77.3 % vs 74.4 % ) , whereas freedom from surgical revascularization was higher after bypass surgery ( 94.3 % vs 86.2 % , P < 0.001 ) . In propensity-score – matched pairs , outcomes did not differ , except for freedom from surgical revascularization , which was significantly higher in the bypass surgery group ( 91.4 % vs 85.3 % at 5 years , P = 0.045 ) . In a subgroup of patients who underwent isolated infrapopliteal revascularization , PTA was associated with better leg salvage ( 75.5 % vs 68.0 % , P = 0.042 ) and somewhat lower freedom from surgical revascularization ( 78.8 % vs 85.2 % , P = 0.17 ) . This significant difference in the leg salvage rate was also observed after adjustment for propensity score ( P = 0.044 ) , but not in propensity-score – matched pairs ( P = 0.12 ) . Conclusions : When feasible , infrapopliteal PTA as a first-line strategy is expected to achieve similar long-term results to bypass surgery in CLI when redo surgery is actively utilized OBJECTIVE Blood supply to the foot is from the posterior tibial , anterior tibial , and the peroneal arteries . Ischemic ulceration of the foot is the most common cause for major amputations in vascular surgical patients . It can be presumed that revascularization of the artery directly supplying the ischemic angiosome may be superior to indirect revascularization of the concerned ischemic angiosome . METHODS This was a prospect i ve study of 64 patients with continuous single crural vessel runoff to the foot presenting with critical limb ischemia from January 2007 to September 2008 .  Direct revascularization ( DR ) of the ischemic angiosome was performed in 61 % ( n=39 ) , indirect revascularization ( IR ) in 39 % ( n=25 ) . Open surgery was performed in 60.9 % and endovascular interventions in 39.1 % . All patients were evaluated for the status of the wound and limb salvage at 1 , 3 , and 6 months . The study end points were major amputation or death , limb salvage , and wound epithelialization at 6 months . RESULTS In the study , 81.2 % of patients had  forefoot ischemia  , 17.2 % had ischemic heel , whereas 1.6 % had  midfoot nonhealing ischemic ulceration . The runoff involved the anterior tibial artery in 42.2 % ( 27/64 ) , posterior tibial artery in 34.4 % ( 22/64 ) , and the peroneal artery in 23.4 % ( 15/64 ) . All patients were followed at 1 , 3 , and 6 months postoperatively for ulcer healing , major amputation , or death . At the end of 6 months , nine patients expired , and six were lost to follow-up . Of 49 patients who completed 6 months , nine underwent major amputation , and 40 had limb salvage . Ulcer healing at 1 , 3 , and 6 months for DR vs IR were 7.9 % vs 5 % , 57.6 % vs 12.5 % , and 96.4 % vs 83.3 % , respectively . This difference in the rates of ulcer healing between the DR and IR groups was statistically significant ( P=.021 ) . The limb salvage in the DR group ( 84 % ) and IR group ( 75 % ) was not statistically significant ( P=.06 ) . The mortality was 10.2 % for DR and 20 % for IR at 6 months . CONCLUSIONS To attain better ulcer healing rates combined with higher limb salvage , direct revascularization of the ischemic angiosome should be considered whenever possible . Revascularization should not be denied to patients with indirect perfusion of the ischemic angiosome as acceptable rates of limb salvage are obtained 
    Output:
    
Wound healing and limb salvage was improved for both open and endovascular intervention .
DR of the tibial vessels appears to result in improved wound healing and limb salvage rates compared with IR , with no effect on mortality or reintervention rates .