Effects of Stents or Prostanoids on Critical Limb Ischemia

Peripheral arterial disease (PAD) affects up to 10% of the global population and is often underdiagnosed and inadequately treated until it progresses to critical limb ischemia (CLI) with rest pain, gangrene, and/or ulceration. At this late stage in PAD management, outcomes are typically measured in terms of amputation or mortality. The 5-year mortality rate has been reported to exceed the likelihood of that due to prostate and breast cancer combined. Structured exercise and/or calf muscle stimulation increased collateral circulation, improving pain, quality of life, and mobility outcomes for patients with all levels of PAD severity. Controversy persists about interventions to optimize related amputation or mortality outcomes in individuals with CLI. Summarized herein, 2 Cochrane reviews clarify the quality and quantity of evidence of the effects on CLI-related outcomes comparing percutaneous transluminal angioplasty (PTA), a procedure for opening infrapopliteal arteries by inflating an endovascular balloon, with or without intravascular stenting, and the use of a systemic prostanoid as compared with a placebo.