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Foot Angiosomes: Instructions for Use.
Roberto Ferraresi1, Giacomo Clerici1, Andrea Casini1
1San Carlo Clinic, Paderno Dugnano, Milano, Italy.
The International Journal of Lower Extremity Wounds
|September 11, 2020
Summary
Angiosome-targeted revascularization improves outcomes for chronic limb-threatening ischemia. However, its practical application is complex due to wound variability and anatomical challenges, necessitating refined usage guidelines.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Podiatric Medicine
Background:
- Angiosome-targeted revascularization has shown promise in improving clinical outcomes for chronic limb-threatening ischemia (CLTI).
- The angiosome concept suggests that revascularizing the specific vascular territory of a wound is crucial for healing.
- Despite evidence, routine application of angiosome-guided therapy in CLTI patients faces practical limitations.
Purpose of the Study:
- To critically evaluate the benefits and limitations of the angiosome concept in managing CLTI.
- To explore the challenges encountered in daily clinical practice when applying angiosome-targeted revascularization.
- To propose practical guidelines for the effective use of the angiosome concept in CLTI treatment.
Main Methods:
- Review of existing literature on angiosome-targeted revascularization in CLTI.
- Analysis of clinical scenarios where angiosome-guided approaches are difficult or impossible.
- Discussion of factors influencing the efficacy of angiosome-guided revascularization, including patient anatomy and wound characteristics.
Main Results:
- While angiosome-targeted revascularization offers potential benefits, its universal application is hindered by complex wound presentations and diverse vascular anatomies.
- The effectiveness of angiosome-guided strategies can be variable, influenced by collateral circulation, revascularization technique, and specific wound conditions.
- Successful implementation requires careful consideration of individual patient factors beyond the strict adherence to angiosome territories.
Conclusions:
- The angiosome concept is valuable but not universally applicable in its current form for all CLTI patients.
- Clinical decision-making for CLTI should integrate the angiosome concept with a thorough assessment of vascular anatomy, collateralization, and wound complexity.
- Development of "instructions for use" is needed to optimize the application of angiosome-targeted revascularization in complex cases.
