title: Chapter III: Management of cardiovascular risk factors and medical therapy.
abstract: Critical limb ischaemia (CLI) is a particularly severe manifestation of lower limb atherosclerosis posing a major threat to both limb and life of affected patients. Besides arterial revascularisation, risk-factor modification and administration of antiplatelet therapy is a major goal in the treatment of CLI patients. Key elements of cardiovascular risk management are smoking cessation and treatment of hyperlipidaemia with dietary modification or statins. Moreover, arterial hypertension and diabetes mellitus should be adequately treated. In CLI patients not suitable for arterial revascularisation or subsequent to unsuccessful revascularisation, parenteral prostanoids may be considered. CLI patients undergoing surgical revascularisation should be treated with beta blockers. At present, neither gene nor stem-cell therapy can be recommended outside clinical trials. Of note, walking exercise is contraindicated in CLI patients due to the risk of worsening pre-existing or causing new ischaemic wounds. CLI patients are oftentimes medically frail and exhibit significant comorbidities. Co-existing coronary heart and carotid as well as renal artery disease should be managed according to current guidelines. Considering the above-mentioned treatment goals, interdisciplinary treatment approaches for CLI patients are warranted. Aim of the present manuscript is to discuss currently existing evidence for both the management of cardiovascular risk factors and treatment of co-existing disease and to deduct specific treatment recommendations.
authors.affiliation: Clinical and Interventional Angiology, Swiss Cardiovascular Centre, University Hospital Berne, Switzerland. diehm@gmx.ch
authors.forename: N
authors.initials: N
authors.lastname: Diehm
authors.forename: J
authors.initials: J
authors.lastname: Schmidli
authors.forename: C
authors.initials: C
authors.lastname: Setacci
authors.forename: J-B
authors.initials: JB
authors.lastname: Ricco
authors.forename: G
authors.initials: G
authors.lastname: de Donato
authors.forename: F
authors.initials: F
authors.lastname: Becker
authors.forename: H
authors.initials: H
authors.lastname: Robert-Ebadi
authors.forename: P
authors.initials: P
authors.lastname: Cao
authors.forename: H H
authors.initials: HH
authors.lastname: Eckstein
authors.forename: P
authors.initials: P
authors.lastname: De Rango
authors.forename: M
authors.initials: M
authors.lastname: Teraa
authors.forename: F L
authors.initials: FL
authors.lastname: Moll
authors.forename: F
authors.initials: F
authors.lastname: Dick
authors.forename: A H
authors.initials: AH
authors.lastname: Davies
authors.forename: M
authors.initials: M
authors.lastname: Lepäntalo
authors.forename: J
authors.initials: J
authors.lastname: Apelqvist
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000517:prevention & control*; D000075202:Contraindications; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000517:prevention & control; D017719:Diabetic Foot / Q000517:prevention & control*; D004032:Diet; D005081:Exercise Therapy; D015316:Genetic Therapy; D006801:Humans; D006949:Hyperlipidemias / Q000517:prevention & control; D006973:Hypertension / Q000517:prevention & control; D007511:Ischemia / Q000517:prevention & control*; D035002:Lower Extremity / Q000098:blood supply*; D016491:Peripheral Vascular Diseases / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011453:Prostaglandins / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D016540:Smoking Cessation; D033581:Stem Cell Transplantation; D014656:Vascular Surgical Procedures
chemical_list: D000319:Adrenergic beta-Antagonists; D010975:Platelet Aggregation Inhibitors; D011453:Prostaglandins