The angiosome concept in clinical practice: implications for patient-specific recanalization procedures

Below-the-knee (BTK) disease with the clinical presentation of critical limb ischemia is associated with a high rate of limb loss due to minor and major amputations. The main problem is to find a way to optimize blood flow to the critical limb area. BTK joint the down-stream diverges into 3 arms which supply different areas. Different concepts exist how optimal blood flow to the critical ischemic areas BTK can be achieved, either by treating as many vessels as can be reopened by an endovascular procedure, or by going for the two main BTK vessels, or in an outstanding situation also to treat the inflow of collaterals to achieve as much blood flow down the foot as possible. Derived from plastic surgery for the purpose of healing of flaps, the angiosome concept has been developed. An angiosome is an anatomic unit of tissue (consisting of skin, subcutaneous tissue, fascia, muscle and bone) fed by a source artery and drained by specific veins. From that point of view it can be presumed that revascularization of the source artery to the angiosome might result in better wound healing and limb salvage rates. The angiosome treatment concept of BTK disease refers to the concept in cardiology, where discrimination of reversible ischemia areas is made and respective vessels leading to these areas are treated in a distinctive way.