Successful Revascularization, Angiosome Concept, and Multivessel Revascularization: Effects on Wound Healing: An
Saritphat Orrapin1,2, Boonying Siribumrungwong1,3
1Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
Insights
Angiosome-targeted revascularization improves outcomes for chronic limb-threatening ischemia (CLTI). Direct revascularization of at least two below-the-knee arteries ensures optimal vessel patency and wound healing in CLTI patients.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Diabetology
Background:
- Chronic limb-threatening ischemia (CLTI) in diabetic patients presents variable outcomes with endovascular revascularization.
- The angiosome concept guides arterial selection for improved wound healing in CLTI.
- Current clinical application of the angiosome concept in daily practice is not well-established.
Purpose of the Study:
- To review the angiosome concept for targeted revascularization in CLTI.
- To summarize evidence for multivessel revascularization in real-world practice.
- To establish evidence-based data for applying angiosome-targeted therapy.
Main Methods:
- Review of recent publications on angiosome-targeted revascularization.
- Analysis of endovascular treatment strategies for CLTI.
- Evaluation of data on vessel patency, wound healing, and limb salvage rates.
Main Results:
- Direct revascularization targeting angiosomes with at least two below-the-knee arteries shows optimal patency and wound healing.
- Angiosome-targeted revascularization demonstrates benefits in CLTI patients.
- Variability in vascular territories and wound locations complicates direct application.
Conclusions:
- Angiosome-targeted revascularization is a promising strategy for CLTI.
- Further evidence is needed to standardize its application in clinical practice.
- Multivessel revascularization guided by the angiosome concept can improve CLTI outcomes.
Abstract:
Endovascular treatment for revascularization in patients with chronic limb-threatening ischemia (CLTI), which is commonly found in patients with diabetes mellitus demonstrates a variable result of vessel patency, wound healing rate, and limb salvage rate. The angiosome concept has been adopted to determine the best target arterial path (TAP) for revascularization for wound healing in CLTI patients. Recent publications demonstrated the benefit of angiosome-targeted revascularization to guide the endovascular treatment in patients CLTI. The best TAP under angiosome concept by direct revascularization with at least 2 of 3 below-the-knee arteries runoff to restore in-line pulsatile blood flow to the ischemic tissue shows the best patency and high rate of wound healing. However, the clinical evidence and application of the angiosome concept in daily practice are difficult and not well established. The vascular territories, collateral vessel, wound area, and locations which associated with angiosome are varied. This article review aims to summarize the concept of angiosome-targeted revascularization and multivessel revascularization for application to the real-world practice under the evidence-based data.
