Critical Limb Ischemia Treatment Strategies in Diabetics: Present Deeds and Future ChallengesCritical Limb Ischemia Treatment Strategies in Diabetics: Present Deeds and Future Challenges

Abstract

The worldwide number of people suffering from diabetes is anticipated to exceed 350 million by 2030 and the risk for developing critical limb ischemia (CLI) has been documented to reach considerably higher levels in these patients. Contemporary data show that 40% to 50% among diabetics may experience an amputation while 20% to 25% are prone to die, during the first year of CLI diagnosis. Despite remarkable advances in peripheral arterial revascularization in the last two decades, major amputation rate seems scarcely affected in this group of patients by simultaneous increase of CLI presentations each year.The present article proposes a succinct review of main revascularization techniques currently reported using surgical, endovascular, or hybrid approaches together with new strategies in enhancing wound-targeted arterial flow reconstruction. Planning to achieve pulsatile flow toward specific foot territories and ischemic ulcers seems to considerably improve the time and quality of tissue healing in diabetic CLI presentation with better limb salvage rates. Novel clinical data equally highlight the importance of parallel macro-and microcirculatory CLI diagnosis inside the multifaceted "diabetic foot syndrome", probably a new paradigm in maximizing postoperative tissue regeneration. In sum, CLI invariably unfolds a multifarious limb-threatening phenomenon particularly pictured in diabetic patients that always have and will request multidisciplinary advises and high-priority local wound and revascularization treatment.