The Foot Angiosomal Source-arteries as Integrated Level of Fractal Vascular Distribution in the Inferior Limb
Taylor and Palmer developed the angiosome definition, which distinguishes unique vascular territories in the human body based on topographic distribution. Centered on fractal branch distribution, this model tends to incorporate a harmonious and much larger arterial irrigation system. At precise levels of segmentation, including the angiosomal source arteries and their appended collaterals, specific arterial pathologies improve characteristic branch affectation.
The current study proposes a brief overview of six levels of arterial division in the inferior limb, including the angiosomal rank. These Levels (I – VI) were analysed (including the angiosomal Level III) and further stratified in attached tables based on subsequent perioperative angiographic observation. An examination of the angiographic characteristics of 341 chronic limb threatening ischemic (CLTI) foot wounds (Rutherford 5-6) was performed retrospectively. The more complex atherosclerotic lesions were chosen for each anatomical level, then compared to adjacent levels in the same CLTI anatomical patterns. In comparison to parallel “associate” atherosclerotic shifts, the heaviest angiographic occlusive lesions (GLASS grades “3-4”) were defined as “dominant” for each ramification. At each of the six levels of arterial branching, a distinction was made between 206 diabetic and 135 non-diabetic CLTI vascular patterns.
The dominant distribution of the occlusive disease was found to vary significantly between the two groups. In non-diabetics, specific “Level I” iliac and typical femoral lesions (10%), along with “Level II” superficial femoral (16%) and femoro-popliteal (33%) dominant occlusions, outperformed parallel iliac (2%), superficial femoral (5%), and femoro-popliteal (14%) occlusive lesions in diabetic CLTI subjects. In diabetic patients, however, “Level II” popliteal and tibial occlusions (33 percent), as well as “Level III” pedal-angiosomal (34 percent) and foot arches occlusions (12 percent), outweighed correspondent popliteo-tibial (28 percent), pedal-angiosomal (9 percent), and unique foot arches (4 percent) occlusions. Significant variations in atherosclerotic affectation of the iliac (p=0.004), femoro-popliteal (p=0.012), angiosomal branches (p0.0001), foot arches, and broad collaterals (p=0.017) between groups verified these trends.
Conclusion: The entire vascular tree of the body has a degressive distribution that is harmonic and balanced. Due to fractal and topographic distribution to the tissues, several Levels (I-VI) of inferior limb arterial repercussions may be individualised as part of a larger vascular network. Specific atherosclerotic arterial changes distinguish diabetic CLTI patients from non-diabetic CLTI patients at these Levels.
Author (s) Details
Vlad Adrian Alexandrescu
Department of Vascular and Thoracic Surgery, Princess Paola Hospital Marche-en-Famenne, IFAC/Vivalia, Belgium
Department of General Surgery, Princess Paola Hospital Marche-en-Famenne, IFAC/Vivalia, Belgium
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