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Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
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Open surgery for chronic limb ischemia: a review.
J B Ricco1, L Thanh Phong, R Belmonte
1Vascular Surgery Department, Jean Bernard Hospital University of Poitiers, Poitiers, France - jeanbaptistericco@gmail.com.
The Journal of Cardiovascular Surgery
|October 16, 2013
Summary
Revascularization strategies for chronic limb ischemia (CLI) lack strong evidence. Best treatment depends on disease extent, patient fitness, and vein availability, often requiring multidisciplinary care.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Clinical Evidence Synthesis
Background:
- Chronic limb ischemia (CLI) presents complex revascularization challenges.
- Clinical evidence guiding therapeutic decisions in CLI is limited.
- Optimal management requires careful consideration of individual patient factors.
Purpose of the Study:
- To review current revascularization strategies for chronic limb ischemia.
- To provide evidence-based recommendations for managing CLI.
- To emphasize the need for a multidisciplinary approach in CLI care.
Main Methods:
- Systematic review of revascularization techniques for CLI.
- Analysis of clinical evidence for different surgical and endovascular approaches.
- Evaluation of graft options, including autologous veins and prosthetic grafts.
Main Results:
- Aortobifemoral bypass is preferred for diffuse aortoiliac disease in surgical candidates.
- Primary stenting is recommended for unilateral iliac occlusion; bypass for extensive iliofemoral disease.
- Saphenous vein bypass is optimal for infrainguinal disease with long occlusions or multiple infrapopliteal lesions.
- Endovascular techniques suit short lesions and limited life expectancy.
- Amputation is sometimes the best option for select CLI patients.
Conclusions:
- Neither an "endo-first" nor a "bypass-first" approach is universally appropriate for CLI.
- CLI management necessitates individualized treatment strategies.
- Specialized, multidisciplinary care is crucial for limb and life preservation in CLI patients.
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