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Below-the-Knee Endovascular Revascularization: A Position Statement.

Jun Li1, Ramon Varcoe2, Marco Manzi3

  • 1University Hospitals Harrington Heart and Vascular Institute, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

JACC. Cardiovascular Interventions
|January 20, 2024
PubMed
Summary
This summary is machine-generated.

Endovascular techniques are crucial for treating below-the-knee peripheral artery disease to prevent limb loss. This review offers expert guidance on patient selection and endovascular strategies for limb salvage.

Keywords:
CLTIbelow the kneechronic limb-threatening ischemiaendovascular revascularization

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Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Endovascular Interventions

Background:

  • Chronic limb-threatening ischemia (CLTI) is the advanced stage of peripheral artery disease (PAD).
  • Below-the-knee (BTK) disease is a common and challenging manifestation of CLTI.
  • Guideline-directed medical therapy alone is often insufficient to prevent amputation in CLTI patients.

Purpose of the Study:

  • To provide expert consensus guidance on endovascular techniques for BTK revascularization.
  • To outline strategies for proper patient selection in BTK interventions.
  • To detail techniques for preventing major amputation and promoting wound healing in CLTI patients.

Main Methods:

  • Consensus review by an international panel of experienced endovascular operators.
  • Synthesis of current best practices and techniques for BTK revascularization.
  • Focus on endovascular approaches to complex below-the-knee disease.

Main Results:

  • Restoration of inline flow is often necessary for limb salvage in BTK disease.
  • Proper patient selection is critical for successful endovascular intervention.
  • Proficiency in endovascular techniques can significantly reduce major amputation rates.

Conclusions:

  • Endovascular revascularization is a vital strategy for managing CLTI and BTK disease.
  • Adherence to expert guidance can optimize outcomes, including wound healing and limb preservation.
  • This review serves as a practical guide for operators managing complex BTK PAD.