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Assessing Therapeutic Angiogenesis in a Murine Model of Hindlimb Ischemia
Published on: June 8, 2019
Critical appraisal of surgical revascularization for critical limb ischemia
1Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA 94143, USA. Michael.conte@ucsfmedctr.org
Insights
Peripheral artery disease (PAD) and critical limb ischemia (CLI) affect millions. Vein bypass surgery remains a primary option for limb preservation in CLI patients, with outcomes depending on patient-specific factors.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease Management
Background:
- Peripheral artery disease (PAD) is a growing global health concern, with critical limb ischemia (CLI) representing its most severe manifestation.
- CLI is linked to significant limb loss, morbidity, and mortality, making limb preservation a critical clinical challenge.
- Traditional revascularization for CLI primarily involved open surgical bypass, but advancements in endovascular techniques have altered practice patterns.
Purpose of the Study:
- To review current data on revascularization strategies for CLI.
- To emphasize the importance of patient selection in optimizing outcomes for both endovascular and open surgical approaches.
- To advocate for a selective approach to CLI revascularization, prioritizing vein bypass in suitable candidates.
Main Methods:
- Review of existing data on endovascular and open surgical revascularization for CLI.
- Analysis of patient-specific factors influencing outcomes, including disease anatomy, vein quality, and comorbidities.
- Synthesis of evidence to support a selective approach to treatment.
Main Results:
- Outcomes for both endovascular and open surgery in CLI are significantly influenced by patient-specific factors.
- Optimal patient selection is crucial for maximizing the benefits of each revascularization technique.
- Vein bypass surgery remains a valuable primary option for appropriately selected CLI patients.
Conclusions:
- A selective approach to revascularization in CLI is recommended.
- Vein bypass surgery should be considered the primary option for limb preservation in carefully selected CLI patients.
- Individualized treatment strategies based on patient factors are essential for successful CLI management.
Abstract:
Peripheral artery disease is growing in global prevalence and is estimated to afflict between 8 and 12 million Americans. Its most severe form, critical limb ischemia (CLI), is associated with high rates of limb loss, morbidity, and mortality. Revascularization is the cornerstone of limb preservation in CLI, and has traditionally been accomplished with open surgical bypass. Advances in catheter-based technologies, coupled with their broad dissemination among specialists, have led to major shifts in practice patterns in CLI. There is scant high-quality evidence to guide surgical decision making in this arena, and market forces have exerted profound influences. Despite this, available data suggest that the expected outcomes for both endovascular and open surgery in CLI are strongly dependent on definable patient factors such as anatomic distribution of disease, vein quality, and comorbidities. Optimal patient selection is paramount for maximizing benefit with each technique. This review summarizes some of the existing data and suggests a selective approach to revascularization in CLI, which continues to rely on vein bypass surgery as a primary option in appropriately selected patients.
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