Deguchi Juno
Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
Ann Vasc Dis. 2020 Jun 25;13(2):126-131. doi: 10.3400/avd.ra.20-00042.
Although several studies showed that angiosome-guided endovascular treatment improved wound healing and major amputation rates in patients with chronic limb-threatening ischemia (CLTI), effectiveness of the angiosome concept to the treatment of ischemic foot remains to be elucidated, especially in bypass surgery. Arterial anatomy of the foot and ankle shows that there are multiple supplementary circulation including arterial-arterial connections and choke nexus, which indicates angiosome concept may carry limited importance in bypass surgery for CLTI. On the other hand, patients with diabetes or renal dysfunction have partial occlusion of arterial-arterial connections and, therefore, quite a few patients with CLTI in Japan may present with limited but impaired supplementary circulation around the ankle. This article reviews the arterial anatomy and circulation of the foot and ankle and discusses availability and limitations of angiosome-guided bypass surgery.
尽管多项研究表明，血管体引导的血管内治疗可改善慢性肢体威胁性缺血（CLTI）患者的伤口愈合及大截肢率，但血管体概念在缺血性足治疗中的有效性仍有待阐明，尤其是在旁路手术中。足踝部的动脉解剖显示存在多种辅助循环，包括动脉-动脉连接和阻塞连接点，这表明血管体概念在CLTI旁路手术中的重要性可能有限。另一方面，糖尿病或肾功能不全患者存在动脉-动脉连接的部分闭塞，因此，日本不少CLTI患者可能存在踝关节周围辅助循环受限但功能受损的情况。本文回顾了足踝部的动脉解剖及循环，并探讨了血管体引导旁路手术的可行性及局限性。
