**2. Anatomy**

Blood supply to the foot is derived from the three tibial vessels, the Anterior tibial artery, the Posterior tibial artery, and the Peroneal artery. These three arteries give rise to six endarteries, each supplying an angiosome (Figure 1).

**1.** The anterior tibial artery supplies the anterior ankle and continues as the dorsalis pedis artery, which supplies the dorsum of the foot. It gives off the lateral tarsal artery and branches into the first dorsal interosseal artery and the arcuate artery supplying the 2-4 interosseal arteries. It has been pointed out that the dorsalis pedis artery is extremely attenuated or absent in 12% of cases [6].

The posterior tibial artery divides into three main branches:


1. Dorsalis pedis angiosome 2. Medial calcaneal artery angiosome 3. Medial plantar artery angiosome

5. Anterior perforating branch angiosome 6. Lateral calcaneal branch angiosome 7. Lateral plantar artery angiosome

4. The hallux, which may be supplied by the feeding arteries of angiosomes 1, 2, or 6

**Figure 1.** Angiosomes shown on the surface of the foot. A. Medial view, B. Dorso-lateral view, C. Plantar view.

The Role of The Angiosome Model in Treatment of Critical Limb Ischemia

http://dx.doi.org/10.5772/54418

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The peroneal artery bifurcates into


The Role of The Angiosome Model in Treatment of Critical Limb Ischemia http://dx.doi.org/10.5772/54418 427

1. Dorsalis pedis angiosome

Perfusion and drainage can occur between angiosomes by means of connecting "choke" ves‐ sels, but this perfusion is less effective than direct supply from the specific feed artery of the angiosome. It is worth noting that the choke vessels are diseased in patients with diabetes and atherosclerosis. This angiosome has had profound impact on the developement of strat‐ egies for plastic and reconstructive surgery. However, only little attention has been paid to the angiosome model in treatment of critical limb ischemia. According to the angiosome model, the specific feed artery – rather than the "best vessel" – should be favoured for revas‐

During the last few years, some studies have compared the results of "best vessel" ver‐ sus "angiosome" directed revascularization. The studies include comparisons of both arteri‐

This chapter aims at describing the role of the angiosome model in critical limb ischemia,

Blood supply to the foot is derived from the three tibial vessels, the Anterior tibial artery, the Posterior tibial artery, and the Peroneal artery. These three arteries give rise to six end-

**1.** The anterior tibial artery supplies the anterior ankle and continues as the dorsalis pedis artery, which supplies the dorsum of the foot. It gives off the lateral tarsal artery and branches into the first dorsal interosseal artery and the arcuate artery supplying the 2-4 interosseal arteries. It has been pointed out that the dorsalis pedis artery is extremely

**2.** The calcaneal branch, which arborizes into multiple braches, that supply the medial and

**3.** the medial plantar artery, supplying the medial, plantar part of the foot. Its boundaries encompass the instep, and, depending on anatomic variability, can include the hallux. **4.** the lateral plantar artery which supplies the lateral midfoot as well as the entire plantar forefoot through the 4 plantar metatarsal arteries that emanate from the deep plantar arch. Normally, this angiosome also includes the plantar aspect of the hallux, depend‐

**6.** a calcaneal branch, supplying the lateral and plantar heel. Together with the calcaneal brach of the posterior tibila artery this artery ensures a double blood supply to the plan‐

**5.** the anterior perforating brach, supplying the lateral anterior upper ankle and

cularization. The foot and ankle area consist of six angiosomes.

and to review the current literature.

arteries, each supplying an angiosome (Figure 1).

attenuated or absent in 12% of cases [6].

plantar portion of the heel,

ing on anatomic variability.

tar aspect of the heel.

The peroneal artery bifurcates into

The posterior tibial artery divides into three main branches:

**2. Anatomy**

426 Artery Bypass

al bypass and percutaneous revascularization based on the two principles


**Figure 1.** Angiosomes shown on the surface of the foot. A. Medial view, B. Dorso-lateral view, C. Plantar view.
