Endovascular first as "preliminary approach" for critical limb ischemia and diabetic foot

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Revascularization Techniques

Background:

• Critical limb ischemia (CLI) and diabetic foot (DB) treatment lacks a definitive gold standard for revascularization.
• Endovascular procedures have significantly impacted surgical revascularization, offering alternatives for patients unsuitable for bypass surgery due to comorbidities or anatomical limitations.

Purpose of the Study:

• To evaluate the role and efficacy of endovascular approaches as a first-line treatment for CLI and DB.
• To discuss the evolving strategies in revascularization, including endovascular, surgical, and hybrid interventions.

Main Methods:

• Review of studies evaluating percutaneous transluminal angioplasty (PTA) for DB and CLI.
• Implementation of an endovascular-first strategy in clinical practice, with surgical or hybrid conversion if necessary.
• Analysis of patient selection criteria, procedural outcomes, and long-term patency rates.

Main Results:

• PTA demonstrates favorable feasibility, technical efficacy, reduced complications, and improved limb salvage rates in CLI and DB.
• While bypass surgery offers better long-term patency, angioplasty is associated with a higher restenosis rate.
• An endovascular-first approach is presented as a viable and potentially superior strategy, regardless of patient comorbidity or disease severity.

Conclusions:

• The endovascular-first strategy is identified as the future direction for treating CLI and DB.
• Vascular surgeons are uniquely positioned to independently decide and perform the most appropriate revascularization intervention, including complex hybrid procedures.