Endovascular therapy for critical limb ischemia

• Published in: Vascular medicine (London, England) Vol. 13; no. 3; pp. 267 - 279
• Main Authors: Arain, Salman A, White, Christopher J
• Format: Journal Article
• Language: English
• Published: London, England Sage Publications 01.08.2008; Arnold; Sage Publications Ltd
• Subjects: Angioplasty, Balloon; Arterial Occlusive Diseases - epidemiology; Arterial Occlusive Diseases - therapy; Atherectomy; Biological and medical sciences; Blood and lymphatic vessels; Blood. Blood coagulation. Reticuloendothelial system; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Drug-Eluting Stents; Humans; Ischemia - epidemiology; Ischemia - therapy; Leg - blood supply; Limb Salvage - methods; Medical sciences; Pharmacology. Drug treatments; Risk Factors; atherosclerosis; stent; peripheral arterial disease; rest pain; angioplasty; Cardiovascular disease; Endovascular route; Instrumental dilatation; Stent; Arterial disease; Vascular disease; Pain; Treatment; Ischemia; Atherosclerosis; Occlusive arterial disease
• ISSN: 1358-863X; 1477-0377
• DOI: 10.1177/1358863X07087129

Abstract Chronic critical limb ischemia (CLI) occurs when arterial perfusion is reduced below a threshold level that results in rest pain and/or tissue breakdown in the lower extremities. Importantly, it is associated with high cardiovascular morbidity and mortality. Without prompt revascularization, CLI may result in loss of a limb (i.e. amputation) and/or life. The goal of endovascular therapy is the re-establishment of pulsatile, straight-line flow to the distal extremity. Percutaneous transluminal angioplasty (PTA) has been shown to be effective and safe in the setting of CLI, with limb salvage rates that compare favorably with surgical procedures. Stents are indicated for failed PTA, while adjunctive therapies such as lasers, thermal angioplasty and atherectomy devices lack data demonstrating improved efficacy compared with conventional lower extremity interventions. In addition to successful revascularization, the institution of lifestyle changes, atherosclerotic risk factor modification, and pharmacologic therapies are indicated to reduce cardiovascular morbidity and mortality.