Clinical implications of the angiosome model in peripheral vascular disease

Abstract

Vascular surgery has seen a revolutionary transformation in its approach to peripheral vascular disease over the last 2 decades, fueled by technological innovation and a willingness by the field to adopt these changes. However, the underlying pathology behind critical limb ischemia and the significant rate of unhealed wounds and secondary amputations despite apparently successful revascularization needs to be addressed. In seeking to improve outcomes, it may be beneficial to examine our approach to vascular disease at the fundamental level of anatomy, the angiosome, to better dictate reperfusion strategies beyond a simple determination of open vs endovascular procedure. We performed a systematic review of the current literature concerning the significance of the angiosome concept in the realm of vascular surgery. The dearth of convincing evidence in the form of prospective trials and large patient populations, and the lack of a consistent, comparable vocabulary to contrast study findings, prevent recommendation of the conceptual model at a wider level for guidance of revascularization attempts. Further well-structured, prospective studies are required as well as emerging imaging strategies, such as indocyanine green dye-based fluorescent angiography or hyperspectral imaging, to allow wider adoption of the angiosome model in vascular operations.

Preventing and treating foot complications associated with diabetes mellitus

“…[74][75][76] Indeed, some evidence sug gests that wound healing and limb salvage is improved 64 with this method, especially for angioplasty, 75,76 although valid criticisms, such as the retrospective nature of these studies, have been raised. 77 A comparison of healing between surgical and endo vascular revascularization techniques revealed that for large wounds, surgical bypass seems to achieve better wound healing than endovascular techniques, in terms of the proportion of patients healed and with a trend for quicker healing. 78 Notably, in this group of patients, the presumption that bypass is dangerous while angioplasty is safe has been challenged by the authors of a review in which 30day mortality was 1.4% for bypass surgery, but mortality was still substantial at 0.5% after revasculari zation.…”

Ulcer Healing After Peripheral Intervention

“…Since Attinger et al advocated the importance of the angiosome concept in lower limb revascularization, 44 the clinical significance has been widely debated ( Table 2). 45 As reported by Alexandrescu et al in their study titled "Angiosome concept: fact or fiction? ", some reports state that the angiosome concept is very useful clinically, while others state that the angiosome concept, though important as a concept, is not of any particular importance clinically.…”

“…There are reports of attempts to evaluate the arterial-arterial connection between angiosomes using local hemodynamic parameters and new imaging methods, as discussed later. 45,[58][59][60][61] Connections between angiosomes and the development of collateral pathways will differ according to the background disease and state of infection. Microcirculatory disorder is often serious in long-term diabetes patients and dialysis patients.…”

Infrapopliteal Bifurcated Dual Run-off Bypass in Critical Limb Ischemia: A Report of 2 Cases

“…Recently, this concept has been used widely for the purpose of foot revascularization in patients with critical limb ischemia (CLI). 1,2 The key benefit of the angiosome-based approach is that it divides areas of ischemic tissue loss into angiosomes and selects the angiosome-matched vessels for revascularization. 3 This could potentially provide optimal conditions for wound healing and limb salvage.…”

“…The plantar heel is also supplied by the medial calcaneal branches of PTA. Reproduced from the figure in previously published article by Sumpio et al1 …”