Abstract
While conservative therapy options are available, the mainstay of treatment for CLI is revascularization, either surgical or endovascular. There are theoretical advantages to basing revascularization upon angiosomes; the six areas of the foot that correspond to areas supplied by the primary arteries and their branches. Intervention upon an artery which correlates with a lesion in the affected angiosome is direct revascularization (DR), and indirect revascularization (IR) is when the two do not correlate. Numerous studies have investigated the efficacy of both DR and IR on wound healing, amputation-free survival, limb salvage, and overall survival with variable results. Data suggests that there is a benefit to DR compared with IR, although IR in patients with collaterals or a patent plantar arch may be just as effective. This is true for both surgical and endovascular approaches without significant difference in outcomes, although surgical revascularization may be better in terms of overall survival in patients expected to live beyond 2 years of follow-up. Future work has yet to be done, particularly with randomized controlled trials, to determine the most appropriate therapy in individual patients.
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Turin, A., Dieter, R.S. (2017). Critical Limb Ischemia and the Angiosome Model. In: Dieter, R., Dieter, Jr, R., Dieter, III, R., Nanjundappa, A. (eds) Critical Limb Ischemia. Springer, Cham. https://doi.org/10.1007/978-3-319-31991-9_33
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DOI: https://doi.org/10.1007/978-3-319-31991-9_33
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