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Endovascular Recanalization for Infrapopliteal Artery Disease in Chronic Limb-Threatening Ischemia: A Practical

Su Hong Kim1, Sang Su Lee2

  • 1Department of Cardiology, Busan Veterans Hospital, Korea Veterans Health Service, Busan, Korea.

Vascular Specialist International
|December 26, 2025
PubMed

Insights

Chronic limb-threatening ischemia (CLTI) in infrapopliteal (IP) arteries presents challenges. This review explores endovascular therapy (EVT) techniques for successful treatment and improved limb salvage in high-risk patients.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Endovascular Therapy

Background:

  • Chronic limb-threatening ischemia (CLTI) affects older adults with comorbidities, increasing amputation and mortality risks.
  • Infrapopliteal (IP) artery disease, often calcified and occluded, is common in CLTI patients with diabetes or end-stage renal disease.
  • Endovascular therapy (EVT) is a primary treatment for CLTI, offering high success and limb salvage rates.

Purpose of the Study:

  • To review current treatment strategies for CLTI involving IP artery disease.
  • To discuss practical techniques for successful EVT in complex IP lesions.

Main Methods:

  • Literature review of current endovascular techniques for IP artery disease in CLTI.
  • Analysis of challenges and solutions for treating long, diffuse, calcified, and totally occluded IP lesions.

Main Results:

  • EVT is a viable first-line treatment for CLTI with IP disease.
  • Complex IP lesions require specific technical approaches for optimal outcomes.
  • Successful EVT can improve limb salvage rates in high-risk CLTI patients.

Conclusions:

  • Effective EVT strategies are crucial for managing CLTI patients with challenging IP artery disease.
  • Further refinement of techniques is needed to enhance long-term durability of EVT for IP lesions.
  • Optimizing EVT success is key to reducing amputation rates in CLTI.

Keywords:
Chronic limb-threatening ischemiaEndovascular proceduresInfrapopliteal arteriesLimb salvagePeripheral artery disease

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