Lower extremity critical limb ischemia: A review of clinical features and management

Area of Science:

• Vascular Surgery
• Cardiology
• Endovascular Interventions

Background:

• Critical limb ischemia (CLI) signifies end-stage atherosclerotic peripheral artery disease, presenting as rest pain and tissue loss.
• CLI is linked to a higher risk of limb amputation and cardiovascular mortality.
• Increasing prevalence is anticipated due to an aging population and risk factors like smoking and diabetes.

Purpose of the Study:

• To review current treatments for CLI, focusing on revascularization strategies.
• To highlight the lack of Level I data guiding the choice between surgical bypass and endovascular intervention for CLI.
• To acknowledge ongoing trials addressing clinical equipoise in CLI treatment.

Main Methods:

• Review of existing literature and clinical guidelines on CLI management.
• Analysis of current revascularization techniques, including surgical and endovascular approaches.
• Identification of gaps in evidence, particularly for patients suitable for both open and percutaneous interventions.

Main Results:

• Revascularization, via surgical bypass or endovascular intervention, remains central to CLI therapy.
• Endovascular modalities are increasingly utilized, but optimal strategy selection is challenging.
• A significant lack of high-level evidence (Level I data) exists to guide treatment decisions in complex CLI cases.

Conclusions:

• Effective management of CLI requires addressing cardiovascular risk factors and preserving limb viability.
• Further research, including ongoing randomized controlled trials, is crucial to establish optimal revascularization strategies for CLI.
• Resolving clinical equipoise between surgical and endovascular approaches is a priority for improving CLI patient outcomes.