Angiosome～From the Standpoint of Bypass Surgery

Area of Science:

• Vascular Surgery
• Anatomy
• Ischemic Limb Disease

Background:

• Chronic limb-threatening ischemia (CLTI) affects wound healing and amputation rates.
• Angiosome-guided endovascular treatment shows promise for CLTI.
• The role of angiosome concept in bypass surgery for ischemic foot is unclear.

Purpose of the Study:

• To review foot and ankle arterial anatomy and circulation.
• To discuss the availability and limitations of angiosome-guided bypass surgery for CLTI.

Main Methods:

• Review of arterial anatomy of the foot and ankle.
• Discussion of supplementary circulation, including arterial-arterial connections and choke nexus.
• Consideration of patient factors like diabetes and renal dysfunction impacting circulation.

Main Results:

• Multiple supplementary circulations exist in the foot and ankle.
• The angiosome concept may have limited importance in bypass surgery for CLTI due to collateral circulation.
• Impaired supplementary circulation in CLTI patients with diabetes or renal dysfunction is noted.

Conclusions:

• Angiosome-guided bypass surgery for CLTI has limitations due to complex foot and ankle arterial anatomy.
• The effectiveness of the angiosome concept in bypass surgery for ischemic foot requires further elucidation, especially in specific patient populations.