Importance of the six angiosomes concept through arterial-arterial connections in CLI.

Abstract

AIM: We reviewed the importance of six angiosomes concept in the foot area through arterial-arterial connections. METHODS: We retrospectively analyzed 145 limbs from 111 critical limb ischemia (CLI) patients to investigate whether the wound location corresponded with the occlusion of the feeding artery. We also analyzed 57 limbs that underwent endovascular therapy (EVT). Regardless of which target vessel underwent EVT in the calf area, it was considered "direct" if the feeding artery flow in the foot area was achieved and "indirect" if not achieved. The wound healing rate was compared between the direct group and the indirect group relative to the six angiosomes of the foot. Further, we analyzed the absolute difference of the skin perfusion pressure (SPP) values measured before and after EVT. RESULTS: A concordance rate of 82.1% (119/145 limbs) was observed between the wound location and the site of vessel occlusion. The wound healing rate of the six angiosomes-direct group was significantly higher than that of the six angiosomes-indirect group (96.6% vs. 72.7%; P=0.03). The SPP values were significantly higher in the six angiosomes-direct group than those in the six angiosomes-indirect group (20.3±18.1 mmHg vs. 5±14.5 mmHg; P=0.039). CONCLUSION: In the case of the patency of the arterial-arterial connections, even if one undergoes EVT for any of the three vessels in the lower leg, wound healing is likely to be achieved, if we can achieve six angiosome-direct flow.