Endovascular therapy for critical limb ischemia.
Critical limb ischemia (CLI) represents an advanced disease state of peripheral arterial disease. It manifests as lower extremity ischemic rest pain or ischemic skin lesions leading to ulceration or gangrene. Patients with CLI often have multiple medical comorbidities and a 1-year mortality rate of 25% and a 1-year amputation rate of 25%. Historically, bypass surgery with autogenous veins for flow restoration has been the first-line therapy for CLI. However, advances in endovascular techniques and device technology have changed the treatment paradigm. Catheter-based technologies are rapidly evolving at a rate that is outpacing large-scale studies evaluating relevant clinical outcomes. Patients with CLI require a multidisciplinary management approach centered on aggressive medical therapies, wound care and prompt revascularization, with an emphasis on limb salvage. This review summarizes the contemporary endovascular therapies including balloon angioplasty, atherectomy and bare-metal stenting. In addition, we review emerging technologies, such as drug-eluting stents, drug-coated balloons and chronic total occlusion recanalization devices.
Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego and VA Medical Center San Diego, 9444 Medical Center Dr, MC 7411, La Jolla, CA 92037, 9444 Medical Center Dr, MC 7411, La Jolla, CA 92037, USA.
Arturo
A
Dominguez
John
J
Bahadorani
Ryan
R
Reeves
Ehtisham
E
Mahmud
Mitul
M
Patel
D000671:Amputation, Surgical; D017130:Angioplasty / Q000379:methods; D017073:Atherectomy / Q000379:methods; D054855:Drug-Eluting Stents; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods; D058729:Peripheral Arterial Disease / Q000601:surgery*; D016896:Treatment Outcome
angioplasty; atherectomy; chronic total occlusion; critical limb ischemia; endovascular; limb salvage; peripheral arterial disease; revascularization; stent