Abstract:

This review is focused on the problem of the angiosome principle of revascularization in critical limb ischemia.

The blood circulation of the foot is described in accordance with the angiosome concept. Different opinions on the application of the angiosome principle of revascularization in critical lower limb ischemia are presented.

Features of the angiosome principle that limit its routine use in clinical practice are described. Also, methods of perfusion evaluation that can be applied at all stages of the treatment process, allow to assess the severity of macro- and microcirculation impairment and result of revascularization are described. 

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Abstract:

The purpose of the study is to evaluate the immediate and long-term effectiveness of percutaneous transluminal angioplasty (PTA) in patients with diabetes mellitus (DM) and critical lower limbs ischemia (CLLI).

Since November 2004 till February 2008 42 PTA were performed in 40 patients with CLLI; 28 (70%) of them had ischemic ulceration, in 6 patients (15%) there were foot gangrene, and 6 patients suffered of ischemic rest pain. 30 patients (75%) had the insulin-dependent DM, 8 patients (20%) took antihyperglycemic drugs, 2 (5%) kept to antihyperglycemic diet. There were the following comorbidities: CAD - 30 patients (75%); arterial hypertension - 31 (77,5%); cerebrovascular insufficiency - 15 (37,5%); chronic renal failure - 8 (20%), and 3 patients (7,5%) were on chronic hemodialisis.

One patient (1,4%) had iliac localization of the lesion, 38 (51,4%) - femoropopliteal disease, and there were infrapopliteal lesions in 35 (47,3%) patients. There were prevalence of TASC type C and type D lesions (89,2%), and 81,5% of all infrapopliteal lesions were occlusions. Subintimal tracking was used in 31,5% of lesions. Stenting performed in 2 cases. Angiography success rate was 92,7% - 37 patients. Clinical improvement registered in 36 (90%) patients. 12-month follow-up showed absence of critical ischemia in 72,8% of cases. 

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