Endovascular Management of Critical Limb Ischemia

Abstract

Endovascular management of critical limb ischemia has advanced significantly in the recent past, especially the ability to treat tibial artery lesions with reasonable results. The indications, results, and technical aspects or endovascular management of CLI is reviewed herein. An algorithm for clinical management of CLI in patients with tibial occlusive disease is also presented.

Primary infragenicular angioplasty for diabetic neuroischemic foot ulcers following the angiosome distribution: a new paradigm for the vascular interventionist?

“…Although surgical bypass still plays a key role in revascularization of critical limb ischemia (CLI),1 increasing clinical experience over the past two decades shows encouraging results for primary endovascular strategies, with acceptable feasibility, low complication rates,2–4 and limb salvage rates comparable with surgery 2–5. Diabetes mellitus is becoming increasingly common in CLI presentations featuring pro-longed foot inflammation or tissue necrosis.…”

“…Diabetes mellitus is becoming increasingly common in CLI presentations featuring pro-longed foot inflammation or tissue necrosis. This currently involves frail patients at high perioperative risk and affected by numerous vascular comorbidities 1,2. This specific patient population, with systemic atherosclerosis, neuroischemic limb ulcers, gangrene, and sepsis (the so-called “diabetic foot syndrome”) is prone to a higher rate of periprocedural surgical complications 1,2,5.…”

“…This currently involves frail patients at high perioperative risk and affected by numerous vascular comorbidities 1,2. This specific patient population, with systemic atherosclerosis, neuroischemic limb ulcers, gangrene, and sepsis (the so-called “diabetic foot syndrome”) is prone to a higher rate of periprocedural surgical complications 1,2,5. Therefore, endovascular techniques may have many applications in this field2 because of their low invasiveness, absence of scarring, and lack of need for venous conduits 2,6,7.…”

“…This specific patient population, with systemic atherosclerosis, neuroischemic limb ulcers, gangrene, and sepsis (the so-called “diabetic foot syndrome”) is prone to a higher rate of periprocedural surgical complications 1,2,5. Therefore, endovascular techniques may have many applications in this field2 because of their low invasiveness, absence of scarring, and lack of need for venous conduits 2,6,7. These strategies seem to have the advantages of enabling simultaneous multiple vessel recanalization with high reproducibility if necessary,6,7 resulting in shorter hospital stays and health care expenditure 1–7…”

Noninvasive measurements of tissue perfusion in critical limb ischemia

“…Non-healing, chronic wounds are particularly relevant in this context. According to the current literature, chronic wounds fail to heal despite successful macroscopic revascularization in 10–18% of cases [1–3]. Given these figures and in addition to considering the macrocirculation in isolation, it is essential to obtain an overall impression of perfusion status, which also includes an assessment of microcirculation.…”