Abstract
Critical limb ischemia (CLI) is defined as chronic rest pain and/or the presence of tissue loss (ulcers or gangrene) in the lower extremities secondary to ischemia. CLI is a limb and potentially life-threatening disease associated with a poor prognosis with only 50% of patients being able to preserve both limbs within 12 months of diagnosis. CLI related to diabetes is often more extensive with multi-level long segmental arterial disease resulting in a 5–30-fold increased rate of amputation. As the incidence and prevalence of diabetes mellitus increases within our aging society, the rate of infrapopliteal artery occlusive disease (IPOD) and the need for intervention rises with it. The aim of this manuscript is to provide the reader with an overview of the various devices available for vessel preparation (VP) and treatment of IPOD in order to optimize patency rates, symptom resolution, healing of wounds, and minimize complications.
Highlights
Critical limb ischemia (CLI) is defined as chronic rest pain and/or the presence of tissue loss in the lower extremities secondary to ischemia
There are limited bailout options when dealing with below the knee (BTK) complications. Those treating patients with CLI and infrapopliteal arterial occlusive disease (IPOD) must be proficient in the various devices available for vessel preparation and treatment in order to minimize complications and optimize patency rates, symptom resolution, and healing of wounds
AFS was significantly worse in the case of drug coated balloons (DCBs) (13.7% crude risk of death or limb loss compared to 9.4% with Percutaneous Transluminal Angioplasty (PTA) (p = 0.008)
Summary
Critical limb ischemia (CLI) is defined as chronic rest pain and/or the presence of tissue loss (ulcers or gangrene) in the lower extremities secondary to ischemia. There are limited bailout options when dealing with below the knee (BTK) complications As a result, those treating patients with CLI and IPOD must be proficient in the various devices available for vessel preparation and treatment in order to minimize complications and optimize patency rates, symptom resolution, and healing of wounds. In this study, they achieved an overall device technical success of 95%, which included 37 IPA lesions [31]. In 2006, Ramaiah et al published their results using the SilverHawk device from their multi-institutional TALON registry, which included 601 patients and 1258 lesions, of which 317 were infrapopliteal They did not discuss their results for IPOD. 2p0r1o3spthecetiLvaesleyreivnailnufarate-dpotphleitueasel aonfdLApoipnliCteLaIl pstaetnieonstiss,(oLfIPwSh) ircehtr3o2s%pecotfivthee treated lesions were BTK These investigators showed a procedural success rate of 88% with mean wound area reduction of 89% at 6 months and a 69% limb salvage rate [39]. The study showed that LA plus PTA had a 5 times greater likelihood of improvement in the IPA lesion severity score compared to PTA alone [41]
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