Importance of vasa nervorum in patients with chronic peripheral arterial disease

Abstract

IntroductionThe cutaneous perfusion of lower limbs influences the surgical treatment of different leg diseases.In 1987, Taylor defined the concept of angiosome in his landmark anatomy study in the field of reconstructive plastic surgery. He divided the body into three‐dimensional anatomic units of tissue, “arteriosomes”, which is supplied by a specific source of arteries. In 2006, Attinger, in turn, divided the foot into six angiosomes supplied by the three main infra genicular arteries and their branches.Our hypothesis is that skin vessels are different in patients with chronic limb ischemia and that the concept of angiosomes based on Attinger's study of healthy limbs is not applicable due to the development of collaterals.Material and methodsThe study was performed on 5 amputation limbs with severe chronic limb ischemia.A barium sulfate suspension (Micropaque®) with colored liquid latex (25%: 75%) was injected under low pressure via femoral artery. Two days after the injection, a CT scan of the specimen was performed using a 64‐row MDCT (Lightspeed, General Electric Healthcare, Milwaukee, USA. As a second step, we dissected the arteries and marked the skin vessels guided by the CT images MPR and MIP.ResultsIn our preliminary surgical anatomical study on 5 amputation specimens, we showed that the progressive evolution of atherosclerosis and the concomitant development of a supply network involving the vascularisation of the sensory nerves implement the limb and foot perfusion.ConclusionArterial distribution in patients with chronic limb ischemia appears to follow partially the concept of angiosomes. Knowledge of collateral vascularization, especially vasa nervorum, can modify the strategies of surgical revascularization. In cases of total occlusion of the main arteries, the knowledge of the vasa nervorum network can be useful in patients in whom direct revascularisation on target angiosome following the angiosome theory is not applicable.Support or Funding InformationNo funding for this studyThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.