Endovascular procedures and new insights in diabetic limb salvage

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Diabetic Foot Management

Background:

• Critical limb ischemia (CLI) impacts a growing patient population, often linked to aging and diabetes.
• CLI presents with rest pain, non-healing wounds, and gangrene due to poor arterial blood supply.
• Diabetic foot ulcers secondary to tibial occlusive disease necessitate limb preservation strategies.

Purpose of the Study:

• To evaluate endovascular therapy as a viable alternative to surgery for CLI.
• To highlight the advancements in treating small-diameter below-the-knee arteries.
• To discuss the potential of evolving endovascular techniques for below-the-knee arterial pathology.

Main Methods:

• Review of current endovascular techniques including angioplasty, stenting, drug-coated balloons, and drug-eluting stents.
• Focus on minimally invasive approaches for below-the-knee arterial disease.
• Assessment of treatment applicability to small-diameter vessels previously untreatable surgically.

Main Results:

• Endovascular therapy provides an alternative to surgery with potentially lower morbidity and mortality.
• Previously inaccessible small-diameter below-the-knee arteries can now be effectively treated.
• A wide array of endovascular tools are available for managing tibial occlusive disease.

Conclusions:

• Endovascular therapy is a valuable option for limb preservation in critical limb ischemia, particularly in diabetic patients.
• Continuous technical and material advancements are expected to further enhance outcomes for below-the-knee interventions.
• Minimally invasive endovascular techniques are increasingly capable of treating most below-the-knee arterial pathologies.