Endovascular management of patients with critical limb ischemia

Abstract

Although primary patency is low, excellent limb salvage rates can be achieved in patients with CLI through close follow-up and secondary interventions. These data, and the 12% annual death rate, validate PTA as first-line therapy in patients with CLI.

Endovascular Treatment for Infrainguinal Vessels in Patients With Critical Limb Ischemia

“…9 Due to recent development of dedicated devices and an accumulation of experience, EVT outcomes have considerably improved and EVT is becoming an alternative first-line option for the treatment of CLI and intermittent claudication. [10][11][12][13][14][15] Despite this major paradigm shift, EVT outcomes have not been systematically compared with those of BS in welldesigned studies. Most studies have been retrospective singlecenter trials involving patients treated for long periods of time, leading to heterogeneity in intervention indications, location of diseased vessels, clinical characteristics, procedural end points, and EVT techniques.…”

Critical limb ischemia: an update for interventional radiologists

“…Lepantalo et al (17), however, reported significantly lower patency rates for stent grafts compared to bypass surgery, with a peri-operative mortality rate of 2.7%, resulting in the premature termination of their randomized clinical trial. Other studies also reported that despite the reduced primary patency, limb salvage rates remain comparable to surgical bypass and range from 74% at five years to 84.7% at eight years (41)(42)(43).…”

“…Given the promising endovascular therapy results, Conrad et al (41) proposed a similar, less invasive treatment procedure involving first-line, palliative PTA treatment with the intention to perform a secondary intervention to maintain patency. This multistage approach has largely been considered only in the aging patient population where open bypass surgery is a less favorable option (41).…”

“…This multistage approach has largely been considered only in the aging patient population where open bypass surgery is a less favorable option (41). Under this consideration, the CLI treatment strategy is shifted towards palliative stent placement with expected secondary patency procedures, and open surgery is limited to patients who have dismal angioplasty results or who do not qualify for endovascular treatment (41,46).…”

The number of patent tibial vessels does not influence primary patency after nitinol stenting of the femoral and popliteal arteries

“…6 Several studies have demonstrated that the number of runoff vessels does influence outcomes in patient populations undergoing PTA alone and those having selective stent placement for the treatment of infrainguinal occlusive disease. 5,7,8 However, the effect of tibial vessel runoff on primarily stented SFA and PA lesions is less well defined. Our objective was to determine whether the number of patent tibial runoff vessels affects patency of primarily stented SFA and PA segments.…”