Critical limb ischemia

Abstract

Critical limb ischemia (CLI) continues to be a significantly morbid disease process for the aging population. Rigid guidelines for the management of patients with CLI are inappropriate due to the complexities that are involved in optimally treating these patients. A thin line exists in the decision process between medical management vs surgical management by revascularization or amputation, and the perception of "success" in this patient population is evolving. This review explores these issues and examines the challenges the treating physician will face when managing the care of patients with CLI. The epidemiology and natural history of CLI is discussed, along with the pathophysiology of the disease process. A review of the literature in regards to the different treatment modalities is presented to help the physician optimize therapy for patients with CLI. New scoring systems to help predict outcomes in patients with CLI undergoing revascularization or amputation are discussed, and an overview of the current status of patient-oriented outcomes is provided. Finally, we briefly examine emerging therapies for the treatment of CLI and provide an algorithm to help guide the practicing physician on how to approach the critically ischemic limb with regard to the complicated issues surrounding these patients.

Diabetes, renal dysfunction, inflammation, and anemia: the deadly quartet in peripheral artery disease

“…The annual mortality rate in pts with CLI is approximately 25% and between 50-70% at 5 years [24]. Pts presenting with CLI and diabetes more often show progression to gangrene, the limb salvage rate is lower, and the results of revascularization are worse compared to nondiabetics [25].…”

Periferinių Arterijų Okliuzinės Ligos Ypatumai Sergant Cukriniu Diabetu: Literatūros Apžvalga

“…Visai neseniai "The Society for Vascular Surgery Lower Extremity Guidelines Committee" sukūrė naują klasifikaciją -"The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System" [21]. Ji remiasi trimis pagrindiniais veiksniais, didinančiais galūnių amputacijų riziką ir apsunkinančiais gydymą: žaizdos pobūdžiu ("wound"), išemija ("ischaemia") ir pėdos infekcija ("foot Infection").…”

“…Tačiau žemiau kelio arterijų atliktų šuntavimo operacijų šiomis medžiagomis išeičių metaanalizė rodo, kad rezultatai yra prasti. 5 metų veikimo dažnis yra tik [19][20][21][22][23][24][25][26][27][28][29][30] teorija ir praktika 2014 -T. 20 (Nr. 4) procentų, priklausomai nuo šunto medžiagos (atšaldytos ir užšaldytos venos, virkštelės venos, užšaldytos arterijos), o pėda išsaugota tik 55-60 proc.…”

Gene Therapy with Non-Viral Vectors For Critical Limb Ischemia: From Bench to Bedside

“…With time, several changes in the structure and function of the vascular tree occur, including diminished sensitivity to vasodilatory stimuli, decreased wall to lumen ratio, lower nitric oxide production, and capillary microthrombi formation due to impaired anticoagulant function of the endothelium (Varu et al, 2010). The natural response to tissue ischemia is the activation of several molecular and cellular pathways that result in the formation of new blood vessels, involving processes such as angiogenesis and arteriogenesis.…”

“…Despite progresses in medical care, the grim significance of CLI diagnosis does not seem to have changed significantly during the last decade, remaining a predictor of poor survival and poor outcomes (Varu et al, 2010). Observational studies of patients with CLI roughly agree on a 50% amputation-free rate after 1 year (with part of these patients still presenting symptoms), 25% of patients undergoing a major amputation and 25% will have died.…”