Below-the-knee Interventions

Abstract

The most common symptom associated with peripheral chronic atherosclerotic disease of the lower limb is intermittent claudication (IC), a cramping pain during walking caused by an inadequate supply of blood to the musculature of the lower limb. CLI is the final stage of PAD, with a typical clinical manifestation of chronic ischemic rest pain (of >2 weeks’ duration), ischemic tissue loss of the limb (ulcers or gangrene), or both. CLI suggests chronicity and should be distinguished from acute limb ischemia [1]. Primary goals of CLI treatment are relief from ischemic pain, healing of neuroischemic ulcers, prevention of limb loss, improvement of patient function and quality of life, and amputation-free survival [1]. Some kind of revascularization, first endovascular and sometimes surgical, is usually necessary to achieve these goals. For some patients, primary amputation may be the only option. Treatment should also be directed toward the pain control, infection control, atherosclerosis control, anticoagulation, and cardiovascular risk management [1, 4].