Critical Limb Ischemia: A Practical Up-To-Date Review

Angiology ◽  
2017 ◽  
Vol 69 (6) ◽  
pp. 465-474 ◽  
Author(s):  
Iacopo Fabiani ◽  
Enrico Calogero ◽  
Nicola Riccardo Pugliese ◽  
Rossella Di Stefano ◽  
Irene Nicastro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Cardiovascular Complications ◽  
Therapeutic Strategies ◽  
Local Infection ◽  
Significant Morbidity ◽  
Peripheral Artery ◽  
Prognostic Stratification ◽  
Artery Disease

Critical limb ischemia (CLI) is the most advanced form of peripheral artery disease. It is associated with significant morbidity and mortality and high management costs. It carries a high risk of amputation and local infection. Moreover, cardiovascular complications remain a major concern. Although it is a well-known entity and new technological and therapeutic advances have been made, this condition remains poorly addressed, with significantly heterogeneous management, especially in nonexperienced centers. This review, from a third-level dedicated inpatient and outpatient cardioangiology structure, aims to provide an updated summary on the topic of CLI of its complexity, encompassing epidemiological, social, economical and, in particular, diagnostic/imaging issues, together with potential therapeutic strategies (medical, endovascular, and surgical), including the evaluation of cardiovascular risk factors, the diagnosis, and treatment together with prognostic stratification.

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

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.

scholarly journals Critical Limb Ischemia: Laporan kasus

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Hermanto Quedarusman ◽  
Pearla Lasut
Keyword(s):  
Diabetes Mellitus ◽  
Blood Sugar ◽  
Critical Limb Ischemia ◽  
Clinical Symptoms ◽  
Limb Ischemia ◽  
Rest Pain ◽  
Peripheral Artery ◽  
History Of ◽  
Artery Disease ◽  
Diabetes Melitus

Abstract: We reported a case of 56 years old man with critical limb ischemia. Diagnosis was made based on anamnesis, signs and clinical symptoms, as well as investigations that included the presence of rest pain in the left leg. Patient also had a history of diabetes mellitus. Echo- doppler and angiographic investigations supported the diagnosis of critical limb ischemia. In this patient, medicamentous treatment has been administered consisted of antiplatelet and cilostazol, blood sugar control by using insulin. The patient also underwent endovascular revascularization.Keywords: critical limb ischemia, peripheral artery diseaseAbstrak: Telah dilaporkan kasus critical limb ischemia pada seorang laki-laki berusia 56 tahun dengan keluhan nyeri seperti terbakar pada kaki kiri bahkan saat istirahat dengan riwayat diabetes melitus. Hasil pemeriksaan penunjang echo-doppler dan angiografi menyokong terdapatnya critical limb ischemia. Diagnosis ditegakkan berdasarkan anamnesis, tanda dan gejala klinis, serta pemeriksaan penunjang. Pada pasien ini, diberikan penatalaksanaan terapi medikamentosa yaitu antiplatelet dan cilostazol, kontrol gula darah dengan menggunakan insulin, dan dilakukan tindakan revaskularisasi endovaskular.Kata kunci: critical limb ischemia, peripheral artery disease

scholarly journals Awareness of Scleroderma Peripheral Artery Disease Presenting With Critical Limb Ischemia in Elderly Patients

2019 ◽  
Vol 83 (5) ◽  
pp. 1081
Author(s):  
Sayaka Funabashi ◽  
Osami Kawarada ◽  
Toru Hirano ◽  
Shinobu Ayabe ◽  
Takeshi Yagyu ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Artery Disease

scholarly journals CKD and Acute and Long-Term Outcome of Patients with Peripheral Artery Disease and Critical Limb Ischemia

2015 ◽  
Vol 11 (2) ◽  
pp. 216-222 ◽  
Author(s):  
Florian Lüders ◽  
Holger Bunzemeier ◽  
Christiane Engelbertz ◽  
Nasser M. Malyar ◽  
Matthias Meyborg ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Artery Disease

Differences Between Patients With Intermittent Claudication and Critical Limb Ischemia Undergoing Endovascular Intervention: Insights From the Excellence in Peripheral Artery Disease Registry

2021 ◽  
Author(s):  
Kunal Patel ◽  
Yulun Liu ◽  
Farshid Etaee ◽  
Chirag Patel ◽  
Peter Monteleone ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Endovascular Intervention ◽  
Baseline Risk ◽  
Peripheral Artery ◽  
Disease Registry ◽  
Endovascular Revascularization ◽  
Artery Disease

Background: There are limited data on differences in angiographic distribution of peripheral artery disease and endovascular revascularization strategies in patients presenting with intermittent claudication (IC) and critical limb ischemia (CLI). We aimed to compare anatomic features, treatment strategies, and clinical outcomes between patients with IC and CLI undergoing endovascular revascularization. Methods: We examined 3326 patients enrolled in the Excellence in Peripheral Artery Disease registry from 2006 to 2019 who were referred for endovascular intervention for IC (n=1983) or CLI (n=1343). The primary outcome was 1-year major adverse limb events, which included death, repeat target limb revascularization, or target limb amputation. Results: Patients with CLI were older and more likely to have diabetes and chronic kidney disease and less likely to receive optimal medical therapy compared with IC. Patients with IC had higher femoropopliteal artery interventions (IC 87% versus CLI 65%; P <0.001), while below the knee interventions were more frequent in CLI (CLI 47% versus IC 12%; P <0.001). Patients with CLI were more likely to have multilevel peripheral artery disease (CLI 32% versus IC 15%, P <0.001). Patients with IC were predominantly revascularized with stents (IC 48% versus CLI 37%; P <0.001) while balloon angioplasty was more frequent in CLI (CLI 37% versus IC 25%; P <0.001). All-cause mortality was higher in patients with CLI (CLI 4% versus IC 2%; P =0.014). Major adverse limb event rates for patients with IC and CLI were 16% and 26%, respectively ( P <0.001) and remained higher in CLI after multivariable adjustment of baseline risk factors. Conclusions: Patients with IC and CLI have significant anatomic, lesion, and treatment differences with significantly higher mortality and adverse limb outcomes in CLI. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01904851.

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