Angiosome-Targeted Endovascular Revascularization in Chronic Limb-Threatening Ischemia

Abstract

Background: Peripheral artery disease (PAD) is a prevalent manifestation of systemic atherosclerosis and a major contributor to cardiovascular morbidity and mortality worldwide. Chronic limb-threatening ischemia (CLTI), the most advanced stage of PAD, is characterized by rest pain, non-healing ulcers, and gangrene, carrying substantial risks of limb amputation and death. Traditional revascularization strategies often fail to account for the anatomical specificity of ischemic tissue zones, prompting growing interest in angiosome-targeted approaches. The angiosome model defines distinct vascular territories of the foot, each supplied by a specific source artery, and has been proposed as a framework for directing endovascular interventions to the precise arterial pathway supplying the ischemic wound. This review examines the pathophysiology, risk factors, and diagnostic modalities for PAD and CLTI, with particular emphasis on the clinical application, outcomes, and limitations of angiosome-guided endovascular revascularization in patients with tissue loss. Current evidence suggests that direct angiosome-targeted revascularization improves wound healing, enhances limb salvage, and reduces major adverse limb events compared to indirect approaches, although the evidence base remains largely observational and requires validation through large-scale randomized controlled trials.