Critical limb ischemia.

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Peripheral Arterial Disease Management

Background:

• Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease, characterized by rest pain, ulcers, or gangrene due to arterial occlusive disease.
• Historically, open surgical bypass was the primary revascularization strategy, but endovascular techniques have expanded treatment options.
• Primary amputation remains an option for select patients unsuitable for revascularization.

Purpose of the Study:

• To review current treatment strategies for critical limb ischemia (CLI).
• To discuss the roles of open surgical bypass, endovascular therapy, and primary amputation in CLI management.
• To highlight the need for evidence-based guidelines for clinical and cost-effective CLI treatment decisions.

Main Methods:

• Review of existing literature and clinical practice guidelines for critical limb ischemia (CLI).
• Analysis of treatment outcomes based on disease location (aortoiliac vs. infrainguinal) and patient factors.
• Individualized treatment decision-making based on life expectancy, functional status, disease anatomy, and surgical risk.

Main Results:

• Endovascular therapy is first-line for most aortoiliac disease, while surgical bypass is preferred for severe cases.
• For infrainguinal disease, vein bypass is favored for suitable patients with a 2-year survival expectancy.
• Endovascular therapy is considered for patients with limited life expectancy, lack of usable vein, or high surgical risk.

Conclusions:

• Treatment decisions for CLI must be individualized, considering patient-specific factors and disease characteristics.
• While endovascular and surgical options are expanding, definitive evidence for optimal strategy selection is still lacking.
• Primary amputation or palliative care may be appropriate for patients with unreconstructable disease or severe comorbidities.