Brodmann M
Division of Angiology, Medical University Graz, Graz, Austria.
J Cardiovasc Surg (Torino). 2013 Oct;54(5):567-71.
Below-the-knee (BTK) disease with the clinical presentation of critical limb ischemia is associated with a high rate of limb loss due to minor and major amputations. The main problem is to find a way to optimize blood flow to the critical limb area. BTK joint the down-stream diverges into 3 arms which supply different areas. Different concepts exist how optimal blood flow to the critical ischemic areas BTK can be achieved, either by treating as many vessels as can be reopened by an endovascular procedure, or by going for the two main BTK vessels, or in an outstanding situation also to treat the inflow of collaterals to achieve as much blood flow down the foot as possible. Derived from plastic surgery for the purpose of healing of flaps, the angiosome concept has been developed. An angiosome is an anatomic unit of tissue (consisting of skin, subcutaneous tissue, fascia, muscle and bone) fed by a source artery and drained by specific veins. From that point of view it can be presumed that revascularization of the source artery to the angiosome might result in better wound healing and limb salvage rates. The angiosome treatment concept of BTK disease refers to the concept in cardiology, where discrimination of reversible ischemia areas is made and respective vessels leading to these areas are treated in a distinctive way.
临床表现为严重肢体缺血的膝下（BTK）疾病与因大、小截肢导致的肢体丢失率高相关。主要问题是找到一种优化关键肢体区域血流的方法。BTK关节下游分为三个分支，为不同区域供血。关于如何实现BTK关键缺血区域的最佳血流存在不同概念，要么通过治疗尽可能多的可通过血管内手术重新开通的血管，要么通过处理两条主要的BTK血管，或者在特殊情况下也治疗侧支血管的流入，以尽可能多地实现足部的血流。为了皮瓣愈合的目的，从整形手术中衍生出了血管体概念。血管体是由一条源动脉供血并由特定静脉引流的组织解剖单位（由皮肤、皮下组织、筋膜、肌肉和骨骼组成）。从这个角度可以推测，对血管体源动脉进行血运重建可能会提高伤口愈合率和肢体挽救率。BTK疾病的血管体治疗概念借鉴了心脏病学中的概念，即在心脏病学中对可逆缺血区域进行区分，并以独特的方式治疗通向这些区域的相应血管。
