Angiosome of the anterior tibial artery - anatomical basis and implications for limb salvage procedures

Abstract

The angiosome concept of the human body describes a number of three-dimensional vascular territories or body blocks called angiosomes that are supplied by specific artery. In 1998 Taylor and Pan studied extensively the angiosomes of the leg. In the area of vascular surgery, the understanding of angiosomes helps in developing preferential strategies for surgical access, vascular reconstruction and amputations. In non-diseased vascular system the neighboring angiosomes are connected by numerous collateral vessels. However, in atherosclerotic patients a huge collateral depletion develops that may jeopardize this natural `rescue system` between adjacent angiosomes. In the present study we describe patients with end stage lower limb ischemia (Fontaine stage IV) and isolated tissue loss and gangrene of the anterior leg compartment corresponding to the anterior tibial artery angiosome. In common surgical practice the preferred treatment for this condition is still above-knee amputation. Another option, demonstrated here, is to perform an isolated excision of the necrotic anterior compartment and to follow a multi step limb salvage treatment.