Arteries of the skin. Two-steps study of arterial topograpy in amputated ischemic limps: Angio CT in hybrid room and anatomical dissection

The arterial anatomy of the skin is known since 1936 when Salmon performed his dissection associated with radiography on cadavers. However, this innovative technique at the time presented some shortcomings with lack of informations. Many anatomical factors influence limb perfusion in patients with critical limb ischemia (CLI) and the principal arteries of the leg are no more the only accountable to ensure the foot perfusion. Our hypothesis is that: perfusion of the foot in CLI is also depending on the status of the perforating arteries, perineural arteries and the presence of a different developments of skin network. The conventional angiography (in vivo) performed in patients with CLI allows to visualize the arteries below the knee but it presents some limits: lack of hemodynamic factors, the amount of contrast agent and radiation hazard and the inability to precisely visualize the perforanting and perineural arteries and skin network. In order to assess the arterial distribution of legs and feet of patients with CLI, we performed a prospective study on amputated limbs: APIA (NCT03618615). After amputation surgery, limbs of consented patients were transported to hybrid operating theatre (Siemens Zeego®) and specimens were prepared for the APIA study. A barium sulfate suspension (Micropaque®) with colored liquid latex (25%: 75%) was injected under low pressure through the popliteal artery. A 3D‐CT was performed on the specimens and the images where treated with the Siemens program for 3D vascular analysis. Afterwards, the specimens were conserved in low temperature room (−4°C) in laboratory of Anatomy of Lorraine University. As a second step, we dissected the arteries guided by the CT images following the perforating and perineural arteries and skin network. This protocol, applied on 5 specimens, is feasible and allows having much important informations about ischemic legs that can help vascular surgeons in therapeutic decisions. Support or Funding Information No funding. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .