Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery

Para-infrared spectroscopy as a tool for selecting a target angiosome for revascularization in patients with diabetic foot

Authors: Tolstokorov A.S., Shchanitsyn I.N., Larin I.V., Balatskiy O.A., Bazhanov S.P.

1 Razumovsky Saratov State Medical University, Saratov, Russian Federation
2 Research Institute of Traumatology, Orthopedics and Neurosurgery, Razumovsky Saratov State Medical University, Saratov, Russian Federation
3 Regional Clinical Hospital, Saratov, Russian Federation

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Link: Clinical Physiology of Blood Circulaiton. 2023; 1 (20): 48-55

Quote as: Tolstokorov A.S., Shchanitsyn I.N., Larin I.V., Balatskiy O.A., Bazhanov S.P. Para-infrared spectroscopy as a tool for selecting a target angiosome for revascularization in patients with diabetic foot. Clinical Physiology of Circulation. 2023; 20 (1): 48–55 (in Russ.). DOI: 10.24022/1814-6910-2023-20-1-48-55

Received / Accepted:  27.01.2023 / 10.03.2023

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Objective. To evaluate the significance of tissue oximetry data in the choice of the target angiosome when planning endovascular intervention on the arteries of the lower extremities in patients with diabetic foot syndrome (DFS).

Material and methods. 36 patients with DFS, tissue oximetry was alternately measured in the projection of angiosomes using the FORE-SIGHT® MS-2000 device (CASMED) and the ankle-brachial index (АBI) was measured in the projection of in the posterior and anterior tibial projections. Tissue oximetry was measured on the dorsum of the foot and the plantar surface of the foot in 20 healthy volunteers.

Results. Patients with DFS, there was a significant (p < 0.05) decrease in StO2 on the dorsum of the foot (9.5%) and sole (11.2%), compared with the results in volunteers. A strong correlation was obtained between the presence of a trophic defect only on the dorsum of the foot and a decrease in StO2 values at points: I (η2= 0.854, p = 0.005), II (η2= 0.819, p = 0.04), IV (η2= 0.919) and V (η2= 0.775, p = 0.039); moderate at point III (η2= 0.677, p = 0.041), as well as between the presence of a trophic defect on the back of the foot and a decrease in ABI values on anterior tibial projections (η2= 0.369, p = 0.011). We did not find such a relationship in other angiosomes.

Сonclusion. Baseline values of tissue oximetry in patients with DFS were significantly lower than in volunteers. We have not found a direct relationship between the presence of a trophic defect in a particular angiosome and a decrease in saturation in the same localization.


  1. Hinchliffe R.J., Forsythe R.O., Apelqvist J., Boyko E.J., Fitridge R., Hong J.P. et al. Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes Metab. Res. Rev. 2020; 36 (1): 1–12. DOI: 10.1002/dmrr.3276
  2. Reed G.W., Raeisi-Giglou P., Kafa R., Malik U., Salehi N., Shishehbor M.H. Hospital readmissions following endovascular therapy for critical limb ischemia: associations with wound healing, major adverse limb events, and mortality. J. Am. Heart Assoc. 2016; 5 (5): 1–9. DOI: 10.1161/JAHA.115.003168
  3. Van den Berg J.C. Angiosome perfusion of the foot: an old theory or a new issue? Semin. Vasc. Surg. 2018; 31 (2–4): 56–65. DOI: 10.1053/j.semvascsurg.2018.12.002
  4. Taylor G.I., Palmer J.H. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br. J. Plast. Surg. 1987; 40 (2): 113–41. DOI: 10.1016/0007-1226(87)90185-8
  5. Attinger C.E., Evans K.K., Bulan E., Blume P., Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast. Reconstr. Surg. 2006; 117 (7): 261–93. DOI: 10.1097/01.prs.0000222582.84385.54
  6. Misra S., Shishehbor M.H., Takahashi E.A., Aronow H.D., Brewster L.P., Bunte M.C. et al. Perfusion assessment in critical limb ischemia: principles for understanding and the development of evidence and evaluation of devices: a scientific statement from the American Heart Association. Circulation. 2019; 140 (12): E657–72. DOI: 10.1161/CIR.0000000000000708
  7. Ma K.F., Kleiss S.F., Schuurmann R.C.L., Bokkers R.P.H., Ünlü Ç., De Vries J.P.P.M. A systematic review of diagnostic techniques to determine tissue perfusion in patients with peripheral arterial disease. Expert Rev. Med. Devices. 2019; 16 (8): 697–710. DOI: 10.1080/17434440.2019.1644166
  8. Serena T.E., Yaakov R., Serena L., Mayhugh T., Harrell K. Comparing near infrared spectroscopy and transcutaneous oxygen measurement in hard-to-heal wounds: a pilot study. J. Wound Care. 2020; 29: S4–9. DOI: 10.12968/jowc.2020.29.Sup6.S4
  9. Mills J.L., Conte M.S., Armstrong D.G., Pomposelli F.B., Schanzer A., Sidawy A.N. et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J. Vasc. Surg. 2014; 59 (1): 220–34. DOI: 10.1016/j.jvs.2013.08.003
  10. Iida O., Soga Y., Hirano K., Kawasaki D., Suzuki K., Miyashita Y. et al. Long-term results of direct and indirect endovascular revascularization based on the angiosome concept in patients with critical limb ischemia presenting with isolated below-the-knee lesions. J. Vasc. Surg. 2012; 55 (2): 363–70. DOI: 10.1016/j.jvs.2011.08.014
  11. Alexandrescu V.A., Brochier S., Limgba A., Balthazar S., Khelifa H., De Vreese P. et al. Healing of diabetic neuroischemic foot wounds with vs without woundtargeted revascularization: preliminary observations from an 8-year prospective dual-center registry. J. Endovasc. Ther. 2020; 27 (1): 20–30. DOI: 10.1177/1526602819885131
  12. Troisi N., Turini F., Chisci E., Ercolini L., Frosini P., Lombardi R. et al. Pedal arch patency and not directangiosome revascularization predicts outcomes of endovascular interventions in diabetic patients with critical limb ischemia. Int. Angiol. 2017; 36 (5): 438–44. DOI: 10.23736/S0392-9590.17.03809-3
  13. Špillerová K., Biancari F., Settembre N., Albäck A., Venermo M. The prognostic significance of different definitions for angiosome-targeted lower limb revascularization. Ann. Vasc. Surg. 2017; 40: 183–9. DOI: 10.1016/j.avsg.2016.06.040
  14. Ubbink D.T., Koopman B. Near-infrared spectroscopy in the routine diagnostic work-up of patients with leg ischaemia. Eur. J. Vasc. Endovasc. Surg. 2006; 31 (4): 394–400. DOI: 10.1016/j.ejvs.2005.10.025
  15. Kayama T., Sano M., Inuzuka K., Katahashi K., Yata T., Yamanaka Y. et al. A pilot study investigating the use of regional oxygen saturation as a predictor of ischemic wound healing outcome after endovascular treatment in patients with chronic limb-threatening ischemia. Ann. Vasc. Dis. 2021; 14 (1): 23–30. DOI: 10.3400/AVD.OA. 20-00132 16. Kagaya Y., Ohura N., Suga H., Eto H., Takushima A., Harii K. “Real angiosome” assessment from peripheral tissue perfusion using tissue oxygen saturation foot-mapping in patients with critical limb ischemia. Eur. J. Vasc. Endovasc. Surg. 2014; 47 (4): 433–41. DOI: 10.1016/j.ejvs.2013.11.011
  16. Boezeman R.P.E., Becx B.P., van den Heuvel D.A.F., Ünlü Ç., Vos J.A., de Vries J.P.P.M. Monitoring of foot oxygenation with near-infrared spectroscopy in patients with critical limb ischemia undergoing percutaneous transluminal angioplasty: a pilot study. Eur. J. Vasc. Endovasc. Surg. 2016; 52 (5): 650–6. DOI: 10.1016/j.ejvs.2016.07.020
  17. Yata T., Sano M., Kayama T., Naruse E., Yamamoto N., Inuzuka K. et al. Utility of a finger-mounted tissue oximeter with near-infrared spectroscopy to evaluate limb ischemia in patients with peripheral arterial disease. Ann. Vasc. Dis. 2019; 12 (1): 36–43. DOI: 10.3400/avd.oa.18-00117
  18. Concepción R.N.A., Riera Del Moral L.F., Gutiérrez N.M., Zafra A.J., Fernández H.Á. Diagnostic validation study. Relationship between optical spectroscopy and ankle brachial index tests for peripheral artery disease. Ann. Vasc. Surg. 2021; 77: 132–7. DOI: 10.1016/j.avsg.2021.06.010
  19. Baltrūnas T., Mosenko V., Mackevičius A., Dambrauskas V., Ašakienė I., Ručinskas K. et al. The use of ear-infrared spectroscopy in the diagnosis of peripheral artery disease: a systematic review. Vascular. 2022; 30 (4): 715–27. DOI: 10.1177/17085381211025174

About Authors

  • Aleksandr S. Tolstokorov, Dr. Med. Sci., Professor, Chief of Chair of Surgery and Oncology; ORCID
  • Ivan N. Shchanitsyn, Cand. Med. Sci., Senior Researcher, Cardiovascular Surgeon; ORCID
  • Igor V. Larin, Postgraduate, Endovascular Surgeon; ORCID
  • Oleg A. Balatskiy, Cand. Med. Sci., Head of Department of Endovascular Surgery; ORCID
  • Sergey P. Bazhanov, Dr. Med. Sci., Neurosurgeon; ORCID

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