Abstract
Emphasis has been placed on the angiosome concept in revascularization of limb salvage therapy. However, not all cases of revascularization apply this concept in the clinical setting. In fact, some cases can be healed without using angiosomes. We examined the significance of the current angiosome concept from the viewpoint of a microcirculation specialist. Endovascular treatment (EVT) and bypass surgery which can recover blood flow cannot save some ischemic limbs of diabetic patients receiving maintenance dialysis, most likely due to complications of macroangiopathy and impaired microcirculation. Though the collateral circulation to the lesions is essential as a route of blood flow for cases without using angiosomes, it is damaged due to impaired microcirculation, decreasing the blood flow to the site. An effective way to prevent this may be the application of EVT to below knee lesions to reconstruct or newly construct angiosomes in the leg and foot. A greater limb salvage rate is expected when EVT is aggressively applied from the leg to the foot in EVT only cases with insufficient blood flow volume or when EVT in the foot is applied to bypass surgery cases. However, further studies are needed to determine long-term results of revascularization of foot lesions.
