Indications and clinical outcomes for below knee endovascular therapy: Review article

Abstract

Chronic critical limb ischemia (CLI) still represents the most common cause for amputation and frequently the possibility for peripheral revascularization, particularly in below knee (BK) arteries, is not adequately evaluated before amputation. This may also be due to the fact that even today, there's some confusion about results of the endovascular treatment in this territory. Diabetics, representing the population most frequently affected by CLI, have specific clinical characteristics, the so called diabetic foot syndrome, which cannot be compared with the situation in nondiabetic patients with ischemic ulcers. Measuring the success of BK endovascular therapy can be a difficult issue, considering that it is often the work of a multidisciplinary team. The clinical benefit of BK endovascular therapy often shows a large discrepancy from the primary patency. While ulcer healing, limb salvage, and reintervention rates are usually low after BK endovascular therapy, rates of restenosis remain excessively high. Nevertheless, the positive impact of revascularization on mortality, which mainly depends on the major amputation rate reduction, is also evident. This review article summarizes indications and clinical outcomes after BK endovascular therapy with special attention to the role of diabetes mellitus in patients with CLI.

The clinical course of critical limb ischaemia and the role of endovascular revascularisation in patients with diabetes

“…Кроме того, рекомендуется частое динамическое наблюдение пациентов после эндоваскулярного лечения, особенно в случае неблагоприятных исходов реваскуляри-зации и гемодинамически значимых осложнений целевых артерий, выявленных в раннем периоде наблюдения [36]. Стратегия эндоваскулярного лечения КИНК у пациентов с СД и у лиц без нарушения углеводного обмена представ-лена в таблице 2 [7].…”

“…Основные показатели оценки эффективности рева-скуляризации конечности и дальнейшей тактики веде-ния больных СД представлены в таблице 3 [7].…”

“…Диагностика КИНК, оценка технической возможности и тактики интервенцион-ного вмешательства часто выполняется неадекватно. До сих пор сохраняются некоторые противоречия от-носительно показаний и результатов эндоваскулярного лечения у пациентов с СД [7].…”

Advances in Endovascular Treatment of Critical Limb Ischemia

“…25 Recanalization of total occlusions is usually associated with lower technical success rates. The introduction of flexible low-profiles balloons in longer lengths (up to 210 mm) has facilitated BTK angioplasty procedures, improving procedure time and potentially reducing dissections in long segments of diffuse disease (Figure 4).…”

Endovascular Treatment of Diabetic Foot in a Selected Population of Patients with Below-the-Knee Disease: Is the Angiosome Model Effective?

“…The primary goal of PTA treatment is to restore the patency of at least one below-the-knee (BTK) vessel, preferably the tributary of the anatomical region of the ulcer [9]. Several studies have demonstrated good results in terms of patency and limb salvage after endovascular treatment of diabetic foot [10][11][12][13][14]. Many, however, are limited by the presence of a heterogeneous population with different stages of ischemia (claudication, rest pain, trophic lesions) and different treatment modalities, with PTA performed both in the above-the-knee (ATK) and BTK areas [15][16][17].…”