Endovascular therapy for critical limb ischemia

Abstract

Critical limb ischemia (CLI) represents an advanced disease state of peripheral arterial disease. It manifests as lower extremity ischemic rest pain or ischemic skin lesions leading to ulceration or gangrene. Patients with CLI often have multiple medical comorbidities and a 1-year mortality rate of 25% and a 1-year amputation rate of 25%. Historically, bypass surgery with autogenous veins for flow restoration has been the first-line therapy for CLI. However, advances in endovascular techniques and device technology have changed the treatment paradigm. Catheter-based technologies are rapidly evolving at a rate that is outpacing large-scale studies evaluating relevant clinical outcomes. Patients with CLI require a multidisciplinary management approach centered on aggressive medical therapies, wound care and prompt revascularization, with an emphasis on limb salvage. This review summarizes the contemporary endovascular therapies including balloon angioplasty, atherectomy and bare-metal stenting. In addition, we review emerging technologies, such as drug-eluting stents, drug-coated balloons and chronic total occlusion recanalization devices.

2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

“…• Leczenie wewnątrznaczyniowe [320][321][322][323][324][325][326] • Klopidogrel preferowany w stosunku do ASA • "zespół naczyniowy" (vascular team) w celu prowadzenia wielodyscyplinarnego leczenia…”

“…Należy podejmować próby rewaskularyzacji w takim zakresie, w jakim jest to możliwe [246,[320][321][322]. Dotychczas tylko w jednej randomizowanej próbie klinicznej, badaniu Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL), bezpośrednio porównano leczenie wewnątrzna-czyniowe z otwartym leczeniem chirurgicznym u pacjentów z CLTI [323].…”

The Development of Robotic Technology in Cardiac and Vascular Interventions

“…Infrapopliteal lesions account for a significant number of PAD treated percutaneously 39. Furthermore these lesions are ideal targets for robotic intervention with the currently available system.…”

Dynamic imaging of allogeneic adipose-derived regenerative cells transplanted in ischemic hind limb of apolipoprotein E mouse model

“…Approximately 4×10 5 ADRCs per well were plated in a six-well plate and then cultured for 48 hours. Three cycles of induction with adipogenic and osteoblast induction medium (Cambrex) were added to the six-well plate to stimulate differentiation of adipocytes and osteoblasts.…”

“…3,4 Rapid and efficient revascularization of ischemic limb is significant to restore the function of lower limbs. 5 Stem cells demonstrate tremendous potential to stimulate differentiation of various tissues, such as ischemic lower limb, 6 cardiac muscle, 7 nerve, 8 and bones. 9 Recent reports have shown that adipose tissues could supply abundant adipose-derived regenerative cells (ADRCs), which are pluripotent stem cells that can self-renew and differentiate into various cell types and can regenerate damaged tissues and organs.…”