Critical Limb Ischemia
Open Access
- 14 April 2010
- journal article
- vascular disease
- Published by Springer Science and Business Media LLC in Current Treatment Options in Cardiovascular Medicine
- Vol. 12 (3), 214-229
- https://doi.org/10.1007/s11936-010-0076-7
Abstract
Critical limb ischemia (CLI), defined as chronic ischemic rest pain, ulcers, or gangrene attributable to objectively proven arterial occlusive disease, is the most advanced form of peripheral arterial disease. Traditionally, open surgical bypass was the only effective treatment strategy for limb revascularization in this patient population. However, during the past decade, the introduction and evolution of endovascular procedures have significantly increased treatment options. In a certain subset of patients for whom either surgical or endovascular revascularization may not be appropriate, primary amputation remains a third treatment option. Definitive high-level evidence on which to base treatment decisions, with an emphasis on clinical and cost effectiveness, is still lacking. Treatment decisions in CLI are individualized, based on life expectancy, functional status, anatomy of the arterial occlusive disease, and surgical risk. For patients with aortoiliac disease, endovascular therapy has become first-line therapy for all but the most severe patterns of occlusion, and aortofemoral bypass surgery is a highly effective and durable treatment for the latter group. For infrainguinal disease, the available data suggest that surgical bypass with vein is the preferred therapy for CLI patients likely to survive 2 years or more, and for those with long segment occlusions or severe infrapopliteal disease who have an acceptable surgical risk. Endovascular therapy may be preferred in patients with reduced life expectancy, those who lack usable vein for bypass or who are at elevated risk for operation, and those with less severe arterial occlusions. Patients with unreconstructable disease, extensive necrosis involving weight-bearing areas, nonambulatory status, or other severe comorbidities may be considered for primary amputation or palliative measures.Keywords
This publication has 73 references indexed in Scilit:
- Disparity in Outcomes of Surgical Revascularization for Limb SalvageCirculation, 2009
- Risk stratification in critical limb ischemia: Derivation and validation of a model to predict amputation-free survival using multicenter surgical outcomes dataJournal of Vascular Surgery, 2008
- AMS INSIGHT—Absorbable Metal Stent Implantation for Treatment of Below-the-Knee Critical Limb Ischemia: 6-Month AnalysisCardioVascular and Interventional Radiology, 2008
- Female gender and oral anticoagulants are associated with wound complications in lower extremity vein bypass: An analysis of 1404 operations for critical limb ischemiaJournal of Vascular Surgery, 2007
- Shifting Paradigms in the Treatment of Lower Extremity Vascular DiseaseAnnals of Surgery, 2007
- Prospective multicenter study of quality of life before and after lower extremity vein bypass in 1404 patients with critical limb ischemiaJournal of Vascular Surgery, 2006
- MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebocontrolled trialThe Lancet, 2002
- Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patientsBMJ, 2002
- Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease; Edinburgh Artery Study Edinburgh Artery StudyEuropean Heart Journal, 1999
- Relationship of severity of lower limb peripheral vascular disease to mortality and morbidity: A six-year follow-up studyJournal of Vascular Surgery, 1989