Endovascular therapy for critical limb ischemia

Abstract

Chronic critical limb ischemia (CLI) occurs when arterial perfusion is reduced below a threshold level that results in rest pain and/or tissue breakdown in the lower extremities. Importantly, it is associated with high cardiovascular morbidity and mortality. Without prompt revascularization, CLI may result in loss of a limb (i.e. amputation) and/or life. The goal of endovascular therapy is the re-establishment of pulsatile, straight-line flow to the distal extremity. Percutaneous transluminal angioplasty (PTA) has been shown to be effective and safe in the setting of CLI, with limb salvage rates that compare favorably with surgical procedures. Stents are indicated for failed PTA, while adjunctive therapies such as lasers, thermal angioplasty and atherectomy devices lack data demonstrating improved efficacy compared with conventional lower extremity interventions. In addition to successful revascularization, the institution of lifestyle changes, atherosclerotic risk factor modification, and pharmacologic therapies are indicated to reduce cardiovascular morbidity and mortality.

ECG-Triggered Non-Contrast-Enhanced MR Angiography (TRANCE) versus Digital Subtraction Angiography (DSA) in patients with peripheral arterial occlusive disease of the lower extremities

“…In our population TRANCE images of the pedal arteries were often greatly impaired. Besides arterial bypass surgery, interventional angioplasty is the most important approach to treating patients with PAOD [15][16][17]. This explains the growing need of preinterventional imaging procedures of the lower extremity vessels to diagnose PAOD before planning PTA or a bypass operation [18].…”

Ultrasound-guided antegrade femoral access: comparison between the common femoral artery and the superficial femoral artery

“…Endovascular therapy often prevents or delays the necessity of a bypass operation or amputation of the affected lower extremity [3][4][5]. There are two basic options to perform access to the lower extremity arteries: Either a retrograde contralateral approach with cross-over advancement of the sheath or an antegrade ipsilateral approach.…”

Endovascular Treatment for Infrainguinal Vessels in Patients With Critical Limb Ischemia

“…1,2 Patients who have CLI typically present with rest pain and ischemic ulcers or gangrene. They have a poor prognosis, with a high mortality rate (19%-54% at 1 year) [3][4][5] and high amputation rate (≥25% at 6 months after failure of primary revascularization). In clinical settings, bypass surgery (BS) has been the gold standard for revascularization in CLI patients because the culprit lesions are commonly occlusive and multilevel or multisegment and BS has been shown to be efficacious and durable.…”