scholarly journals Commentary on Pedal Revascularization: Extending the Limits of Endovascular or Surgical Means to Prevent Amputation

2021 ◽  
Vol 6 (2) ◽  
pp. 1-4
Author(s):  
Richard F Neville ◽  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
State Of The Art ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Below The Knee ◽  
Recent Advances ◽  
Primary Amputation

Critical limb ischemia carries risk of significant morbidity and mortality and revascularization is particularly challenging in patients with tibial and pedal arterial disease. Recent advances in both endovascular therapies and open revascularization techniques have expanded our ability to treat patients with below the knee disease who may otherwise be subject to amputation. This commentary briefly reflects on emerging endovascular and open revascularization techniques for limb salvage in complex below knee arterial disease in order to raise awareness and minimize primary amputation without attempts at these “state of the art” modalities.

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

VASA ◽  
2009 ◽  
Vol 38 (1) ◽  
pp. 3-12 ◽  
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.

Comparison of Results in Endovascular Interventions for Infrainguinal Lesions: Claudication versus Critical Limb Ischemia

2005 ◽  
Vol 71 (6) ◽  
pp. 474-480 ◽  
Author(s):  
Susan M. Trocciola ◽  
Rabih Chaer ◽  
Rajeev Dayal ◽  
Stephanie C. Lin ◽  
Naveen Kumar ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Clinical Success ◽  
Ankle Brachial Index ◽  
Duplex Ultrasound ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Endovascular Interventions

This study analyzed clinical success, patency, and limb salvage after endovascular repair in patients treated for chronic limb ischemia presenting with claudication versus critical limb ischemia. Between October 2001 and August 2004, 115 patients (mean age 71) underwent endovascular treatment for infrainguinal arterial disease. Techniques included subintimal angioplasty and transluminal angioplasty with or without stents. Lesions were classified according to Transatlantic InterSociety Consensus. Follow-up (mean 11 months) included physical exam, ankle-brachial index, and duplex ultrasound. Patency rates were determined using Kaplan-Meier and compared by log-rank analysis. One hundred ninety-nine lesions were treated in 121 limbs using percutaneous techniques. Comorbidities were similar except higher rates of diabetes mellitus (67% vs 41%, P < 0.001) and chronic renal insufficiency (22% vs 7%, P < 0.05) were found in critical limb ischemia patients. Primary patency for claudicants was 100 per cent, 98 per cent, and 85 per cent at 3, 6, and 12 months and 89 per cent, 80 per cent, and 72 per cent for critical limb ischemia, respectively ( P = 0.06). Limb salvage was 91 per cent at 12 months for critical limb ischemia patients. Morbidity was similar between groups, and there was no perioperative mortality. Percutaneous intervention for both claudication and critical limb ischemia provides acceptable 12-month patency with limited morbidity.

Endovascular Therapy as the Primary Approach for Limb Salvage in Patients with Critical Limb Ischemia: Experience with 443 Infrapopliteal Procedures

Vascular ◽  
2006 ◽  
Vol 14 (2) ◽  
pp. 63-69 ◽  
Author(s):  
Marc Bosiers ◽  
Joseph P. Hart ◽  
Koen Deloose ◽  
Jurgen Verbist ◽  
Patrick Peeters
Keyword(s):  
Limb Salvage ◽  
Excimer Laser ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Primary Treatment ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Endovascular Intervention ◽  
Below The Knee ◽  
Surgical Data

Endovascular strategies for the treatment of critical infrageniculate peripheral arterial occlusive disease exist and are becoming the primary methodology for such lesions at many centers. Although technically feasible for experienced operators, the evidence to support this strategy for below the knee (BTK) interventions is still evolving. We studied the 6-month and 1-year outcomes of percutaneous transluminal angioplasty (PTA) alone, PTA with stenting, and excimer laser recanalization for BTK lesions in patients with critical limb ischemia. Between September 2002 and June 2005, 443 patients (355 Rutherford category 4, 82 category 5, 6 category 6) underwent intervention for 681 BTK lesions. Follow-up was performed at 6-month intervals after index intervention: limb salvage data were recorded and duplex ultrasonography was performed to measure the patency of treated areas. The primary patency and limb salvage rates of the entire population were 85.2% and 97.0% and 74.2% and 96.6% at 6 months and 1 year, respectively. Stratified for the treatment strategy (PTA alone in 79, PTA with stenting in 300 patients, and excimer laser in 64), 1-year primary patency rates were 68.6%, 75.5%, and 75.4%, whereas the limb salvage rates were 96.7%, 98.6%, and 87.9% for each modality, respectively. Endovascular intervention will become the primary treatment for BTK lesions in patients with critical limb ischemia, with 1-year primary patency and limb salvage rates that compare favorably with published surgical data. Prospective, randomized, multicenter trials will be needed to further establish the role of endovascular intervention in this challenging patient group.

Digital Subtraction Angiography Prior to an Amputation for Critical Limb Ischemia (CLI): An Expert Recommendation Statement From the CLI Global Society to Optimize Limb Salvage

2020 ◽  
Vol 27 (4) ◽  
pp. 540-546 ◽  
Author(s):  
Jihad A. Mustapha ◽  
Fadi A. Saab ◽  
Brad J. Martinsen ◽  
Constantino S. Pena ◽  
Thomas Zeller ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Digital Subtraction ◽  
Global Society ◽  
Expert Recommendation ◽  
Below The Knee ◽  
Artery Disease ◽  
Quality Imaging

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.

scholarly journals Endovascular revascularization of multilevel arterial disease in patients with critical limb ischemia

2018 ◽  
Vol 5 (6) ◽  
pp. 2039
Author(s):  
Asser Abd El Hamid Goda
Keyword(s):  
Wound Healing ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Healing Rate ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Endovascular Revascularization ◽  
The Mean ◽  
Revascularization Procedures ◽  
Salvage Rate

Background: Critical limb ischemia (CLI) occurs due to progressive obstructive nature of atherosclerosis disease.  Nowadays, there is widespread use of endovascular revascularization procedures for restoration of blood flow in CLI. The aim this study is evaluation of the efficacy of endovascular intervention for multilevel arterial disease in patients with critical limb ischemia.Methods: This prospective study was included CLI patients due to multilevel arterial disease who underwent endovascular revascularization between January 2016 and January 2017 in our institution. Study end points were limb salvage and wound healing. Results: The mean age of patients was (61.7±7.47) years, with 13 (61.9%) men. Eight limbs were identified as Rutherford category 4 (38.1%), ten limbs as Rutherford category 5 (47.6%), and three limbs as Rutherford category 6 (14.3%). Limb salvage rate was (90.5%) at 1 year. Wound healing rate was 80.9%.Conclusions: This study proved that endovascular revascularization of multilevel arterial disease for patients with critical limb ischemia is effective.

scholarly journals Characteristics and Outcome for Persons with Diabetic Foot Ulcer and No-Option Critical Limb Ischemia

2020 ◽  
Vol 9 (11) ◽  
pp. 3745
Author(s):  
Marco Meloni ◽  
Valentina Izzo ◽  
Valerio Da Ros ◽  
Daniele Morosetti ◽  
Matteo Stefanini ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Major Amputation ◽  
Peripheral Arterial ◽  
Stage Renal Disease

The study aimed to evaluate clinical and vascular characteristics, as well as outcomes, for diabetic persons with foot ulceration and no-option critical limb ischemia (CLI). The study group included a sample of patients admitted to our diabetic foot unit because of a new diabetic foot ulcer and CLI. All subjects were managed using a limb salvage protocol which includes lower-limb revascularization. According to whether or not the revascularization procedure was a success, patients were respectively divided into two groups: successfully treated CLI patients (ST-CLI) and no-option CLI patients (NO-CLI). Failed revascularization was considered in the case of technical recanalization failure of occluded vessels (inability to overcome the obstruction) and/or absence of arterial flow to the foot. Limb salvage, major amputation, and death after 1 year of follow-up were evaluated and compared between the two groups. Overall, 239 patients were included, 74.9% belonging to ST-CLI and 25.1% to NO-CLI. NO-CLI patients reported more cases of ischemic heart disease (80 vs. 62.1, p = 0.008), heart failure (63.3 vs. 32.4%, p < 0.0001), and end-stage renal disease (ESRD) (60 vs. 25.7%) than ST-CLI patients. In addition, more vessels were affected in the NO-CLI group (5.2 ± 1.6 vs. 4 ± 1.5, p < 0.0001), and there was more involvement of tibio-peroneal trunk (50 vs. 30.2%, p = 0.006), anterior tibial (93.3 vs. 82.7, p = 0.03), posterior tibial (93.3 vs. 73.7%, p = 0.0005), peroneal (70 vs. 48%, p = 0.002), and below-the-ankle arteries (73.3 vs. 39.1%, p < 0.0001) than ST-CLI. The 1 year outcomes for the whole population were 69.9% limb salvage, 10.9% major amputation, and 19.2% death. The outcomes for NO-CLI and ST-CLI were, respectively, as follows: limb salvage (13.8 vs. 73.4%, p < 0.0001), amputation (30 vs. 4.5%, p = 0.0001), and mortality (50 vs. 8.9%, p < 0.0001). NO-CLI patients showed a more severe pattern of peripheral arterial disease (PAD) with distal arterial lesions and worse outcomes than ST-CLI.

scholarly journals Successful limb salvage by endovascular treatment for critical limb ischemia subsequent to acute limb ischemia

2019 ◽  
Vol 2019 (10) ◽  
Author(s):  
Tetsuya Nomura ◽  
Satoshi Tasaka ◽  
Kenshi Ono ◽  
Yu Sakaue ◽  
Naotoshi Wada ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Major Amputation ◽  
Sudden Onset ◽  
Acute Limb Ischemia ◽  
Below The Knee ◽  
Tibial Arteries ◽  
Chronic Critical Limb Ischemia ◽  
Peripheral Arterial

Abstract Recently, there have been increasing opportunities to treat patients with peripheral arterial disease. Of those patients, both pathological conditions, such as acute limb ischemia (ALI) and chronic critical limb ischemia (CLI), are closely associated with high risks of major amputation, disability and death. We encountered a very rare case of CLI subsequent to ALI. An 83-year-old male showed the sudden onset of ALI, probably due to thromboembolism from an abdominal aortic aneurysm during an operation for gastric cancer. The patient was referred to another hospital for Fogarty thrombectomy. About 1 month after ALI onset, necrosis of the left first toe gradually progressed. On angiography of the left lower limb, we noted occlusions of both anterior and posterior tibial arteries. Then, we successfully conducted balloon angioplasty for the below-the-knee arteries. Thereby, favorable blood flow was achieved, which led to successful wound healing without amputations.

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