Lower extremity revascularization via endovascular and surgical approaches: A systematic review with emphasis on combined inflow and outflow revascularization

Abstract

This review is intended to help clinicians and patients understand the present state of peripheral artery disease, appreciate the progression and presentation of critical limb ischemia/chronic limb-threatening ischemia, and make informed decisions regarding inflow and outflow endovascular revascularization and surgical treatment options within the context of current debates in the medical community. A controlled literature search was performed to obtain research on outcomes of critical limb ischemia patients undergoing complete leg revascularization for peripheral artery disease inflow and outflow disease. Data for this review were identified by queries of medical and life science databases, expert referral, and references from relevant papers published between 1997 and 2019, resulting in 48 articles. The literature review herein indicates that endovascular revascularization—including ballooning, stenting, and atherectomy—is an effective peripheral artery disease therapy for both above the knee and below the knee disease, and can safely and effectively treat both inflow and outflow disease. As such, it plays a leading role in the therapy of lower extremity artery disease.

Technical Success and Mid-Term Outcomes of Endovascular Revascularization of Tibio-Peroneal Trunk Lesions

“…Besides the best medical treatment, and a multidisciplinary team approach [11,12], revascularization is often needed to avoid a major amputation. Limb-salvage rates after infrapopliteal endovascular recanalization are reported between 65% and 98.4% after 1 year [13,14], with technical success rates varying from 70 to 100% [14][15][16][17][18]. These outcomes are not directly comparable to the results of the current study, because they pertain almost exclusively to tibial lesions as opposed to isolated or continuous TPT lesions.…”

Effects of Infra-malleolar Status According to Global Limb Anatomic Staging System on Clinical Outcomes in Patients With Chronic Limb-Threatening Ischemia

“…The fundamentals of GLASS include restoration of inline flow to the ankle and foot as the anatomic goal of revascularization in CLTI, the definition of preferred TAP, and the assessment of limb-based patency. 15 Target arterial path is generally selected based on the least diseased crural artery that provides runoff to the foot. It can also be selected based on the angiosome preference vessel.…”

Contemporary treatment of below‐the‐knee peripheral arterial disease in patients with chronic limb threatening ischemia: Observations from the Vascular Quality Initiative

“…This decision is often complex and the result of local expertise and practice, patient‐related characteristics, and anatomical considerations. In recent years, newer devices and approaches have made lesion length, lesion location, and vessel calcification less of an obstacle for successful endovascular intervention 37 . This, in combination with increased operator experience, shorter duration of hospital stay, and decreased medical expenditures, have resulted in an increased interest in endovascular approaches.…”