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Angiosomes: Targeting the Wound, Not the Artery
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As the field of endovascular intervention has evolved, a concept has emerged that has been shown to improve amputation-free survival when compared with revascularizing thwe best available artery: angiosome-based revascularization.
Figure. The foot and ankle can be divided into six territories called angiosomes, based on the artery supplying them. The concept can help in locating the obstruction in the specific artery in patients with lower-extremity ischemic ulcers and in planning revascularization.
Reprinted with permission from Shishehbor MH. Clev Clin J Med. 2014;81:209-216. Copyright © 2014 Cleveland Clinic Foundation. All rights reserved.
Angiosomes, which are regions of vascularization supplied by specific arteries, can be located on the skin. There are six angiosomes perfused by three arteries in the foot and lower leg region. The arteries branch off the popliteal artery once it passes behind the knee and include:
- The anterior tibial artery, which supplies blood to the dorsum of the foot and the front of the lower limb;
- The posterior tibial artery, which supplies the plantar surface of the foot;
- The peroneal artery, which supplies the lateral portion of the foot.
“In the angiosome concept, we try to bring blood flow directly to where the wound is located and we feel that this allows for the fastest healing and best outcomes,” said Mehdi H. Shishehbor, DO, MPH, PhD. “And the sooner we can heal the ulcer, the sooner our patients can be active and bear pressure on their legs.”