title: The Importance of Patency in Patients with Critical Limb Ischemia Undergoing Endovascular Revascularization for Infrapopliteal Arterial Disease.
abstract: Critical limb ischemia (CLI) represents the most severe form of peripheral arterial disease (PAD) and frequently occurs in medically frail patients. CLI patients frequently exhibit multi-segmental PAD commonly including the tibial arterial segment. Endovascular therapy has been established as first-line revascularization strategy for most CLI patients. Restenosis was reported to occur in up to more than two-thirds of CLI patients undergoing angioplasty of complex tibial arterial obstructions. Nevertheless, favorable clinical outcomes were observed for infrapopliteal angioplasty when compared with bypass surgery, despite higher patency rates for the latter. Based on these observations, infrapopliteal patency was considered to be only of secondary importance upon clinical outcomes in CLI patients. In contrast to these earlier observations, however, recent findings from two randomized clinical trials indicate that infrapopliteal patency does impact on clinical outcomes in CLI patients. The purpose of the present manuscript is to provide a critical reappraisal of the present literature on the clinical importance of tibial arterial patency in CLI patients undergoing endovascular revascularization and to discuss utility and limitations of currently available anti-restenosis technologies.
authors.affiliation: Miami Cardiac and Vascular Institute, Baptist Hospital , Miami, FL , USA.
authors.forename: Frederic
authors.initials: F
authors.lastname: Baumann
authors.affiliation: Clinical and Interventional Neuroradiology, University Hospital Bern , Bern , Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ozdoba
authors.affiliation: Clinical and Interventional Angiology, Kantonsspital Aarau , Aarau , Switzerland.
authors.forename: Ernst
authors.initials: E
authors.lastname: Gröchenig
authors.affiliation: Clinical and Interventional Angiology, Kantonsspital Aarau , Aarau , Switzerland ; University of Applied Sciences Furtwangen , Villingen-Schwenningen , Germany.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Diehm
keywords: below the knee; critical limb ischemia; endovascular revascularization; patency