Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
Thammasat University-Center of Excellence for Diabetic Foot care (TU-CDC), Thammasat University Hospital, Pathum Thani, Thailand.
Int J Low Extrem Wounds. 2024 Mar;23(1):12-18. doi: 10.1177/15347346231212330. Epub 2023 Nov 6.
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.
血管内治疗慢性肢体缺血性疾病（CLTI）的血运重建，常见于糖尿病患者，其血管通畅率、创面愈合率和肢体存活率的结果各不相同。血管生成体概念已被用于确定 CLTI 患者创面愈合的最佳靶动脉通路（TAP）。最近的出版物证明了血管生成体靶向血运重建在指导 CLTI 患者的腔内治疗中的益处。在血管生成体概念下，通过直接血运重建，至少有 3 条膝下动脉的通畅来恢复向缺血组织的搏动性血流，显示出最佳的通畅率和高创面愈合率。然而，血管生成体概念在临床实践中的应用证据和应用是困难的，尚未得到很好的确立。血管区域、侧支血管、创面面积和与血管生成体相关的部位都是不同的。本文综述旨在总结血管生成体靶向血运重建和多血管血运重建的概念，并将其应用于基于证据的数据的真实世界实践中。
