Angiosomes: How Do They Affect My Treatment?

Palena, Luis Mariano; García, Luis Fernando; Brigato, Cesare; Sultato, Enrico; Candeo, Alessandro; Baccaglini, Tommaso; Manzi, Marco

doi:10.1053/j.tvir.2014.08.004

Cited by 16 publications

(8 citation statements)

References 29 publications

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“…8–10 This angiosome model (called traditional angiosome in this project) divides the foot into three angiosomes: medial plantar, lateral plantar, and calcaneal angiosomes. These angiosomes are supplied by blood flow from medial plantar, lateral plantar, and medial calcaneal arteries, respectively.…”

mentioning

confidence: 99%

“…The angiosome concept, defined by Taylor and Palmer in 1987, 7 has been increasingly incorporated into endovascular procedures to treat patients with foot ulcers. [8][9][10] This angiosome model (called traditional angiosome in this project) divides the foot into three angiosomes: medial plantar, lateral plantar, and calcaneal angiosomes. These angiosomes are supplied by blood flow from medial plantar, lateral plantar, and medial calcaneal arteries, respectively.…”

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confidence: 99%

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Oximetric angiosome imaging in diabetic feet

Zheng

Muccigrosso

Zhang

et al. 2016

Magnetic Resonance Imaging

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Purpose To develop a noncontrast oximetric angiosome imaging approach to assess skeletal muscle oxygenation in diabetic feet. Materials and Methods In four healthy and five subjects with diabetes, the feasibility of foot oximetry was examined using a 3T clinical magnetic resonance imaging (MRI) scanner. The subjects’ feet were scanned at rest and during a toe-flexion isometric exercise. The oxygen extraction fraction of skeletal muscle was measured using a susceptibility-based MRI method. Our newly developed MR foot oximetric angiosome model was compared with the traditional angiosome model in the assessment of the distribution of oxygen extraction fraction. Results Using the traditional angiosome during the toe-flexion exercise, the oxygen extraction fraction in the medial foot of healthy subjects increased (4.9 ± 3%) and decreased (−2.7 ± 4.4%) in subjects with diabetes (difference = 7.6%; 95% confidence interval = −13.7 ± 1.4; P = 0.02). Using the oximetric angiosome, the percent difference in the areas of oxygen extraction fraction within the 0.7–1.0 range (expected oxygen extraction fraction during exercise) between rest and exercise was higher in healthy subjects (8 ± 4%) than in subjects with diabetes (4 ± 4%; P = 0.02). Conclusion This study demonstrates the feasibility of measuring skeletal muscle oxygen extraction fraction in the foot muscle during a toe-flexion isometric exercise. Instead of assessing oxygen extraction fraction in a foot muscle region linked to a supplying artery (traditional angiosome), the foot oximetric angiosome model assesses oxygen extraction fraction by its different levels in all foot muscle regions and thus may be more appropriate for assessing local ischemia in ulcerated diabetic feet.

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confidence: 99%

Oximetric angiosome imaging in diabetic feet

Zheng

Muccigrosso

Zhang

et al. 2016

Magnetic Resonance Imaging

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“…Simply stated, this concept implies that 1 runoff vessel is better than none, 2 or 3 is better than 1, and that the tibial arteries are more important than the peroneal artery (as they enter the foot directly). 7 The second concept involves the selection of a particular target vessel that is most likely to perfuse the area of tissue loss-the so-called "woundrelated artery" theory. When determining which vessel is supplying the region of an ulcer, conceptualizing the foot in terms of specific "angiosomes" is extremely helpful.…”

Section: Introductionmentioning

confidence: 99%

Determining End Points for Critical Limb Ischemia Interventions

Cooper

Peña

Benenati

2016

Techniques in Vascular and Interventional Radiology

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“…[8][9][10] This angiosome model (called traditional angiosome in this project) divides the foot into three angiosomes: medial plantar, lateral plantar, and calcaneal angiosomes. These angiosomes are supplied by blood flow from medial plantar, lateral plantar, and medial calcaneal arteries, respectively.…”

Section: Hhs Public Accessmentioning

confidence: 99%

“…11 Furthermore, assessment of the effectiveness of the vascular treatment still mostly relies primarily on the toe pressure or transcutaneous oxygen tension (TcPO 2 ), which may not be a sensitive indicator of the perfusion in the specific area where the wound is located. 9,10 In addition to the observation that toe pressure often fails to assess the specific region at risk (ie, the wound), toe pressures cannot be obtained on patients with a toe amputation. TcPO 2 cannot assess perfusion beyond the skin, a critical limitation when the wound bed extends beyond the epidermis, into the dermis and muscles of the foot.…”

mentioning

confidence: 99%

Oximetric angiosome imaging in diabetic feet

Zheng

Muccigrosso

Zhang

et al. 2016

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Purpose-To develop a noncontrast oximetric angiosome imaging approach to assess skeletal muscle oxygenation in diabetic feet.Materials and Methods-In four healthy and five subjects with diabetes, the feasibility of foot oximetry was examined using a 3T clinical magnetic resonance imaging (MRI) scanner. The subjects' feet were scanned at rest and during a toe-flexion isometric exercise. The oxygen extraction fraction of skeletal muscle was measured using a susceptibility-based MRI method. Our newly developed MR foot oximetric angiosome model was compared with the traditional angiosome model in the assessment of the distribution of oxygen extraction fraction.Results-Using the traditional angiosome during the toe-flexion exercise, the oxygen extraction fraction in the medial foot of healthy subjects increased (4.9 ± 3%) and decreased (−2.7 ± 4.4%) in subjects with diabetes (difference = 7.6%; 95% confidence interval = −13.7 ± 1.4; P = 0.02).Using the oximetric angiosome, the percent difference in the areas of oxygen extraction fraction within the 0.7-1.0 range (expected oxygen extraction fraction during exercise) between rest and exercise was higher in healthy subjects (8 ± 4%) than in subjects with diabetes (4 ± 4%; P = 0.02).Conclusion-This study demonstrates the feasibility of measuring skeletal muscle oxygen extraction fraction in the foot muscle during a toe-flexion isometric exercise. Instead of assessing oxygen extraction fraction in a foot muscle region linked to a supplying artery (traditional angiosome), the foot oximetric angiosome model assesses oxygen extraction fraction by its different levels in all foot muscle regions and thus may be more appropriate for assessing local ischemia in ulcerated diabetic feet.Foot disorders (such as ulceration, infection, and gangrene) are the leading causes of hospitalization in patients with diabetes mellitus (DM). 6 One key prognostic factor that is currently lacking in diabetic foot care is an accurate indicator of the local microvascular bed basal flow (skeletal muscle perfusion) and responsiveness (skeletal muscle oxygenation) to help guide diagnosis and intervention. HHS Public AccessThe angiosome concept, defined by Taylor and Palmer in 1987, 7 has been increasingly incorporated into endovascular procedures to treat patients with foot ulcers. [8][9][10] This angiosome model (called traditional angiosome in this project) divides the foot into three angiosomes: medial plantar, lateral plantar, and calcaneal angiosomes. These angiosomes are supplied by blood flow from medial plantar, lateral plantar, and medial calcaneal arteries, respectively. After identifying the artery responsible for perfusing the angiosome in which the ulcer is located, directed revascularization of that end-artery is undertaken to optimize healing. However, this angiographic angiosome may not be appropriate to address the local tissue perfusion that cannot be visualized by angiography, especially in patients with DM. 11 Furthermore, assessment of the effectiveness of the vascular ...

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Angiosomes: How Do They Affect My Treatment?

Cited by 16 publications

References 29 publications

Oximetric angiosome imaging in diabetic feet

Oximetric angiosome imaging in diabetic feet

Determining End Points for Critical Limb Ischemia Interventions

Oximetric angiosome imaging in diabetic feet

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