Jornal de relatos de casos clínicos

Complex Lower Limb Revascularization Based on Angiosomes Concept: A Case Report

Abstract

Mircea I. Popitiu, Mihai Ionac, Crina Solomon, Vlad Alexandrescu and Bogdan Timar

Introduction: The angiosome concept was first described in 1987, defining an angiosome as an area of tissue comprising skin, subcutaneous tissue, fascia, muscle and bone supplied by a specific artery and drained by a specific vein. We report a case of a patient who was successfully complex revascularized by open surgery and endovascular techniques based on angiosome concept.

Case presentation: A 73-years-old male patient with critical limb ischemia and type 2 diabetes, presented increasing resting pain in the lower right limb during the last 3 months, followed by necrosis of distal phalanx of I and II toes, wet interdigital necrosis of toes I-II on the right leg, with absence of distal pulses on both limbs. Direct flow into affected angiosome was successfully achieved with right proximal femoral-popliteal saphenous vein bypass and ATA balloon dilatation angioplasty.

Conclusion: The vascular patient with critical ischemia associated to diabetes currently requires a complex treatment including open surgery, endovascular technique and negative pressure therapy to save the lower limbs. The angiosome concept is useful during both open and endovascular tibial revascularisation.