Advances in Endovascular Treatment of Critical Limb Ischemia

Abstract

Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease. In the absence of timely revascularization, CLI carries high risk of mortality and amputation. Over the past decade, endovascular revascularization has rapidly become the preferred primary treatment strategy for CLI, especially for the treatment of below-the-knee disease. Advances in percutaneous devices and techniques have expanded the spectrum of patients with CLI who are deemed candidates for revascularization. This review will focus on advances in endovascular options for the treatment of CLI, in particular for below-the-knee disease. (Circ J 2011; 75: 756 - 765)

Diabetes and Old Age Could Affect Long-Term Patency of Paramalleolar Distal Bypass for Peripheral Arterial Disease in Japanese Patients

“…20 Although there were several reports that suggested that this was advantageous for compromised patients, recently published final BASIL trial data confirm the superiority of open surgical bypass. 21 Moreover, some doctors have warned that bypass operation after failed angioplasty is not as successful as initial bypass operation.…”

Critical limb ischemia: an update for interventional radiologists

“…ing autologous veins has and continues to be considered the most favorable treatment for CLI, endovascular techniques, including percutaneous transluminal angioplasty (PTA), have improved and now rival surgical bypass in terms of patient risk factors (11,30,31) (Fig. 2).…”

“…This was the first study to support primary stent placement in the lower extremities. More recently, studies have also demonstrated that balloon PTA procedures can result in a 77%-100% technical success rate in BTK intervention (11). Furthermore, the recent introduction of long, low profile angioplasty balloon catheters and microwire systems have improved endovascular treatment approaches by extending the range of lesions that are treatable with a primary endovascular technique (11).…”

“…More recently, studies have also demonstrated that balloon PTA procedures can result in a 77%-100% technical success rate in BTK intervention (11). Furthermore, the recent introduction of long, low profile angioplasty balloon catheters and microwire systems have improved endovascular treatment approaches by extending the range of lesions that are treatable with a primary endovascular technique (11). One study of 58 patients treated with long low-profile 80 -to 120-mm angioplasty balloons reported a 15-month 100% limb salvage rate (11).…”

“…Clinically, CLI is manifested by resting ischemic pain, tissue death (e.g., extremity ulcers), and compromised hemodynamics (e.g., cold extremities) (1,5,11). The most widely accepted explanation of CLI proposes that the vascular pathology results from a prolonged, chronic imbalance of vascular supply versus demand (5,12).…”