PREDICTORS OF EARLY MORTALITY IN PATIENTS WITH CRITICAL LIMB ISCHEMIA CAUSED BY ISOLATED BELOW-THE-KNEE ARTERY DISEASE

Despite recent guideline updates on peripheral artery disease (PAD) and critical limb ischemia (CLI) treatment, the optimal treatment for CLI is still being debated. As a result, care is inconsistent, with many CLI patients undergoing an amputation prior to what many consider to be mandatory: consultation with an interdisciplinary specialty care team and a comprehensive imaging assessment. More importantly, quality imaging is critical in CLI patients with below-the-knee disease. Therefore, the CLI Global Society has put forth an interdisciplinary expert recommendation for superselective digital subtraction angiography (DSA) that includes the ankle and foot in properly indicated CLI patients to optimize limb salvage. A recommended imaging algorithm for CLI patients is included.

Download Full-text

New techniques for endovascular treatment of peripheral artery disease with focus on chronic critical limb ischemia

VASA ◽

10.1024/0301-1526.38.1.3 ◽

2009 ◽

Vol 38 (1) ◽

pp. 3-12 ◽

Cited By ~ 10

Author(s):

Zeller ◽

Sixt ◽

Rastan

Keyword(s):

Limb Salvage ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Arterial Disease ◽

Limb Loss ◽

Infrapopliteal Artery ◽

Below The Knee ◽

Chronic Critical Limb Ischemia ◽

Artery Disease ◽

Peripheral Arterial

Chronic critical limb ischemia (CLI) represents the most advanced stage of peripheral arterial disease. CLI is associated with a high risk for limb loss and revascularization, either by surgical or endovascular means, is absolutely mandatory. With traditional techniques such as balloon angioplasty, limb salvage was reported in 80 to 90%. However, in case of failed revascularization attempt, limb loss was 40 to 50% and mortality approximately 20%. This review summarizes new developments in endovascular techniques which increase the acute and chronic success rate of endovascular procedures and therefore potentially further improve limb salvage rates. Special crossing and re-entry devices designed for femoro-popliteal application may even facilitate recanalization of long chronic occlusions. Improved stent design, atherectomy devices and drug coated balloons improve patency rates and may result in improved wound healing rates. Moreover, downsizing the catheter tools for infrapopliteal artery disease opens new horizons also for the treatment of complex below-the-knee lesions representing an increasing patient population due to the increasing prevalence of diabetes and end-stage renal failure.

Download Full-text

Predictors of Mortality within 2-year After Endovascular Therapy for Patients with Critical Limb Ischemia Due to Isolated Below-the-knee Lesions

Cardiovascular Intervention and Therapeutics Japanese Edition ◽

10.15245/cvit.6.44 ◽

2014 ◽

Vol 6 (1) ◽

pp. 44-47

Author(s):

Tatsuya Shiraki ◽

Osamu Iida ◽

Shin Okamoto ◽

Takayuki Ishihara ◽

Tomoharu Dohi ◽

...

Keyword(s):

Endovascular Therapy ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Predictors Of Mortality ◽

Below The Knee

Download Full-text

Faculty Opinions recommendation of Pathology of peripheral artery disease in patients with critical limb ischemia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733896223.793553737 ◽

2018 ◽

Author(s):

Joseph Emmerich

Keyword(s):

Peripheral Artery Disease ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Peripheral Artery ◽

Artery Disease

Download Full-text

Multi-Level Lower Extremity Arterial Revascularization Via Retrograde Pedal Access Under Local Anesthesia in a Patient With Severe Cardiopulmonary Comorbidities: A Case Report

Vascular and Endovascular Surgery ◽

10.1177/15385744211026451 ◽

2021 ◽

pp. 153857442110264

Author(s):

Hee Korleski ◽

Laura DiChiacchio ◽

Luiz Araujo ◽

Michael R. Hall

Keyword(s):

Case Report ◽

General Anesthesia ◽

Peripheral Artery Disease ◽

Critical Limb Ischemia ◽

Treatment Modality ◽

Conventional Treatment ◽

Limb Ischemia ◽

Peripheral Artery ◽

Endovascular Revascularization ◽

Artery Disease

Background: Chronic limb-threatening ischemia is a severe form of peripheral artery disease that leads to high rates of amputation and mortality if left untreated. Bypass surgery and antegrade endovascular revascularization through femoral artery access from either side are accepted as conventional treatment modalities for critical limb ischemia. The retrograde pedal access revascularization is an alternative treatment modality useful in specific clinical scenarios; however, these indications have not been well described in literature. This case report highlights the use of retrograde pedal access approach as primary treatment modality in a patient with an extensive comorbidities precluding general anesthesia nor supine positioning. Case Presentation: The patient is a 60-year-old female with multiple severe cardiopulmonary comorbidities presenting with dry gangrene of the right great toe. Her comorbidities and inability to tolerate supine positioning precluded her from receiving open surgery, general anesthesia or monitored sedation, or percutaneous femoral access. Rather, the patient underwent ankle block and retrograde endovascular revascularization via dorsalis pedis artery access without post-operative complications. Discussion: The prevalence of comorbidities related to peripheral artery disease is increasing and with it the number of patients who are not optimal candidates for conventional treatment methods for critical limb ischemia. The retrograde pedal access revascularization as initial treatment modality offers these patients an alternative limb salvaging treatment option.

Download Full-text