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Angiosome System and Principle

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Abstract

Despite high-performance modern interventional techniques and undeniable clinical medical progress, critical limb ischemia (CLI) persists to threaten large groups of patients afflicted by peripheral arterial occlusive disease. Among new contemporary strategies for revascularization, the angiosome concept was designed to enhance ischemic tissue regeneration in below-the-knee wound-targeted revascularizations. At present, 30 years after its first description in plastic surgery and following a decade of vascular applications for limb salvage, new questions arise in with regard to use in current clinical practice. What exactly does angiosome-directed revascularization mean, what diagnostic method best matches the ischemic foot angiosomal distribution, what specific changes warrant tibial angioplasty versus bypass in topographic foot revascularization, and how do we assess clinical success among distinct phases of tissue reperfusion and cicatrization, are some of the questions challenging interventionists. Other open issues concern the technical feasibility of an angiosome-guided strategy in daily practice and indications for this approach in specific «collateral-deprived» groups of CLI patients.

Despite a lack of consistency in available clinical studies, several contemporary meta-analyses suggest that angiosome-oriented revascularization, whenever technically feasible, by using main tibial trunks, accessible foot arches and collateral channels, may enhance and stabilize post-ischemic tissue regeneration. However, modest differences in limb salvage and survival rates are reported by some authors when comparing direct versus indirect revascularization strategies. This chapter presents the main characteristics of this continuously evolving approach and highlights observations and challenges of this appealing concept in lower limb revascularization interventions.

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  1. Cardio-Vascular and Thoracic Surgery Department, CHU Sart Tilman Hospital, University of Medicine, Liège, Belgium

    Vlad-Adrian Alexandrescu MD & Jean-Olivier Defraigne MD, PhD

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  1. Vlad-Adrian Alexandrescu MD
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Correspondence to Vlad-Adrian Alexandrescu MD .

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  1. Middle German Heart Center and Health Care Center Bitterfeld-Wolfen, gGmbH, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Alexandrescu, VA., Defraigne, JO. (2018). Angiosome System and Principle. In: Lanzer, P. (eds) Textbook of Catheter-Based Cardiovascular Interventions. Springer, Cham. https://doi.org/10.1007/978-3-319-55994-0_77

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