Angiosome System and Principle

Alexandrescu, Vlad; Defraigne, Jean-Olivier

doi:10.1007/978-3-319-55994-0_77

Cited by 3 publications

(23 citation statements)

References 61 publications

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“…Thorough knowledge of the EAOD may help clinicians to better understand why blood flow from "a few millimeters of skin to the entire diabetic foot or leg" World Journal of Cardiovascular Diseases [88] relies on specific nourishing vessels that are solely derived from one angiosome-dependent artery [7] In fact, it appears that WTR and EAOD theories together may both afford useful synergies in treating collateral deprived diabetic CLTI patients [17] [26].…”

Section: Current Literature Review Concerning Dr/wtr Strategiesmentioning

confidence: 99%

“…1) What specifically defines today the term "direct revascularization" (DR), wound-directed, or "angiosome-guided" revascularization? Beyond targeting the principal angiosomal arteries (Figure 1), should the main regional collaterals, the arterial-arterial communicants and the foot arches also be included in a [19], there is still a lack of consensus concerning quantitative and qualitative collateral support in AC definition [17] [26]. The related clinical success following DR/WTR needs similar standardization [17] [26].…”

Section: New Interrogations In Angiosome-oriented Revascularizationmentioning

confidence: 99%

“…Performing WTR implies supervision of precise diagnostic and therapeutic stages, each gathering specific challenges and individual defiance factors. From a pragmatic perspective the high frequency of severe atherosclerotic disease, long occlusions and dense calcifications currently encountered in specific angiosomal "source arteries" to treat [26] [27] still represents a daily challenge for every committed interventionist.…”

Section: New Interrogations In Angiosome-oriented Revascularizationmentioning

confidence: 99%

“…In these patients, parallel efforts were exerted to improve the mean time to limb tissue recovery and decrease amputation rates by implementing the DR/WTR strategies [16] [17] [18] [19] [24]. This hypothesis also focuses on specific foot wound topographic reperfusion either via specific angiosomal branches (DR) or by using available local collateral reserves (WTR) [5] [10] [17] [18] [19] [26] in each given CLTI pattern, if technically attainable.…”

Section: Introductionmentioning

confidence: 99%

“…observed similar clinical effects for analogous, collateral-enhanced revascularizations [3] [18] [55]. Large collaterals (around 1-mm diameter) and direct arterial-arterial interconnections seem to play a crucial role [17][26] in appropriate ischemic foot reperfusion Nevertheless, certain levels of clinical success have World Journal of Cardiovascular Diseases also been reported using the current practice for indirect revascularization (IR), without deliberate topographical orientation[20] [21] …”

mentioning

confidence: 96%

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Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

Alexandrescu¹,

Sinatra²,

Maufroy³

2019

WJCD

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Despite a lack of solid evidence in applying the angiosome concept (AC) in current chronic limb threatening ischemia (CLTI) treatment, several encouraging results for improved wound healing and less for limb preservation were reported in various consistency studies. Direct revascularization (DR) following the foot angiosomes distribution (whenever feasible) may afford better clinical results compared to angiosome indifferent, or indirect revascularization (IR), however without clear benefit on survival and for major adverse limb events (MALE). Inside this interrogation, the notable influence of the remnant collaterals, the foot arches, the wound characteristics, and the type of revascularization (bypass versus endovascular) still remain ardent topics. Current evidence suggests that applying DR in daily vascular practice requires practitioners to be committed to every individual hemodynamic variable in a thorough macro-and micro-vascular evaluation of the ischemic foot. It becomes clearer nowadays that not all CLTI foot ulcers hold same ischemic burden and seemingly need specific DR. In the same setting, a novel wound targeted revascularization (WTR) design was proposed assembling wider circulatory targets than genuine DR notion, as used by some authors. Beyond specific angiosomal artery reperfusion, WTR associates the available arches, the large-and medium-sized collaterals, and the arterial-arterial communicants, in an intentional "source artery" and "collateral" topographic foot revascularization. However, up to date, the notion of angiosome wound-guided revascularization (DR and WTR) detains only a reserved level of confirmation. As for DR, the WTR equally needs higher levels of evidence allowed by standardized definition, uniform indications, and pertinent results from multicenter larger prospective analysis, before large application.

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Section: Current Literature Review Concerning Dr/wtr Strategiesmentioning

confidence: 99%

Section: New Interrogations In Angiosome-oriented Revascularizationmentioning

confidence: 99%

Section: New Interrogations In Angiosome-oriented Revascularizationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 96%

See 3 more Smart Citations

Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

Alexandrescu¹,

Sinatra²,

Maufroy³

2019

WJCD

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A systematic review and meta-analysis of endovascular angiosomal revascularization in the setting of collateral vessels

Kim

Meshkin

Tirrell

et al. 2021

Journal of Vascular Surgery

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Healing of Diabetic Neuroischemic Foot Wounds With vs Without Wound-Targeted Revascularization: Preliminary Observations From an 8-Year Prospective Dual-Center Registry

Alexandrescu¹,

Brochier²,

Limgba³

et al. 2019

J Endovasc Ther

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Purpose: To assess the clinical efficacy of endovascular angiosome-oriented wound-targeted revascularization (WTR) vs indirect (wound-indifferent) revascularization (IR) in diabetic patients with neuroischemic foot ulcers. Materials and Methods: Between April 2009 and July 2017, 167 diabetic patients (mean age 72.8 years; 137 men) with chronic limb-threatening ischemia (Rutherford category 5) and foot wounds (Wagner 2–4) in 194 limbs were prospectively registered and scheduled for primary infragenicular endovascular treatment. Specific angiosome source artery reperfusion sustained by patent foot arches or arterial-arterial connections was attempted initially. If this approach failed, topographic revascularization via available collaterals (WTRc) and IR were sequentially attempted. Results: Reperfusion was successful in 176 (91%) of 194 limbs (113 with WTR, 28 with WTRc, and 35 with IR); the global angiosome-oriented technical success (WTR and WTRc) was 73% (141/194). The mean follow-up was 10.9±0.7 months (range 3–12.5). Over 1 year, 102 (58%) of the 176 successfully treated limbs experienced wound healing [79/113 (70%) in the WTR group, 15/28 (54%) in the WTRc group, and 7/35 (20%) in the IR group; p=0.011]. The mean time to healing was 6.8±0.4 months in the WTR group, 7.9±0.6 months in the WTRc group, and 9.8±0.7 months in the IR group (p=0.001). Relapses were noted in 18 (16%) WTR limbs, 5 (18%) WTRc limbs, and 6 (17%) IR limbs. Comparison between WTR and IR and WTRc vs IR showed improved cicatrization in the angiosome-oriented groups (p<0.05). Major adverse limb events (MALE) and limb salvage were different between WTR and WTRc and between WTR and IR groups (p<0.05), while WTRc vs IR was not. Amputation-free survival was not influenced by the revascularization strategy (p=0.093). Conclusion: Wound healing in diabetic patients with chronic limb-threatening ischemia appeared to be improved by intentional wound-targeted revascularization, but no uniform benefit concerning MALE or limb preservation was observed. IR still represents an alternative for limb salvage in cases in which angiosome-guided revascularization fails.

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Angiosome System and Principle

Cited by 3 publications

References 61 publications

Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

Current Issues and Interrogations in Angiosome Wound Targeted Revascularization for Chronic Limb Threatening Ischemia: A Review

A systematic review and meta-analysis of endovascular angiosomal revascularization in the setting of collateral vessels

Healing of Diabetic Neuroischemic Foot Wounds With vs Without Wound-Targeted Revascularization: Preliminary Observations From an 8-Year Prospective Dual-Center Registry

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