What is it about?

The angiosome concept appears increasingly cited in the current treatment of critical limb ischemia and limb salvage. However, its current utilization by bypass or endovascular techniques only began in recent years. “Angiosome-guided” or “direct revascularization” has been increasingly utilized with particular soar in the field of endovascular interventional techniques. However, there are still some unanswered questions about the current technical feasibility of this strategy in the actual management of chronic limb-threatening ischemia, concerning definitions for direct (DR) versus indirect revascularization (IR), and clear indications for the use of bypass versus endovascular techniques in specific high-risk groups of patients. This chapter analyzes the main possible benefits of angiosome-guided direct revascularization, also the unanswered questions focusing on this continually evolving strategy for revascularization and limb salvage.

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Why is it important?

Our multidisciplinary diabetic foot team uses the Angiosomes concept in revascularization since 2003. AAlong all these years, we witnessed inherent changes in the anatomical and the physiological interpretation of this strategy that are summarized in this chapter.

Perspectives

Despite lack of pertinent data in current CLTI treatment, angiosome-guided revascularization appears preferable for inducing better wound cicatrization and limb salvage, whenever technically achievable. Higher levels of evidence for the use of direct revascularization in the daily management of CLTI based on standardized definitions, anatomic and functional diagnostics, and uniform indications for each type of treatment are required. Larger multicentric and prospective studies are therefore expected before routine application of this strategy in current clinical practice. Since direct revascularization proves difficult to achieve, alternative indirect reperfusion via available foot collaterals is recommended.

MD, PhD, Vlad Adrian Alexandrescu
Consultant, University Hospital CHU Liège

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This page is a summary of: Angiosome concept for vascular interventions, January 2022, Elsevier,
DOI: 10.1016/b978-0-12-822546-2.00020-4.
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