No abstract

Some patients with peripheral arterial disease may present with critical limb ischemia, a condition associated with high rates of morbidity and mortality. Early diagnosis and effective medical therapy and revascularization are indicated to avoid amputation and reduce mortality. Ideally, a multidisciplinary approach with collaboration between endovascular interventionist, vascular surgeons, podiatrist, infectious disease, and wound care specialist is recommended for these patients.

Peripheral arterial disease (PAD) is a common manifestation of atherosclerotic vascular disease and the incidence of infrapopliteal PAD continues to rise in the population. The historical experience with surgical and endovascular interventions for infrapopliteal stenosis was disappointing as operators experienced high rates of early technical failures and procedural complications, coupled with high rates of restenosis in this vascular territory when compared with more proximal vascular beds. While patients with infrapopliteal PAD may be asymptomatic, the majority would ultimately develop intermittent claudication or may also present with critical limb ischemia. In this article, we review the current literature, and discuss some of the technical aspects of endovascular therapy in this vascular bed. We also emphasize the importance of adjunctive evidence-based therapies such as antiplatelet agents, statins, and lifestyle modification such as smoking cessation in this particularly high-risk cohort to optimize clinical outcomes.

Stroke remains a major cause of morbidity and mortality worldwide. Despite preventive measures, effective management strategies are needed to reduce the morbidity and mortality associated with this devastating condition. While the management of hemorrhagic stroke is mostly limited to supportive care, reperfusion strategies in ischemic stroke have been developed and continue to evolve. Conceptually, the pathophysiology of ischemic stroke is similar to that of acute myocardial infarction and the objective of management is similar (ie, to rapidly restore normal flow to reduce permanent damage). It is, therefore, not surprising that the management of acute ischemic stroke includes intravenous (IV) thrombolysis, the only Food and Drug Administration (FDA)-approved strategy at this point. In addition, there are a myriad of emerging endovascular interventional techniques. We review the current literature and discuss some of the technical aspects of endovascular therapy in the setting of acute ischemic stroke.

REVIEW ■ ABSTRACTEx vivo tests of platelet function show that platelet function and the response to antiplatelet therapy vary markedly from person to person. But just how clinically significant are ex vivo measurements of platelet function, and will changes we make based on such information translate into improved outcomes for patients? The authors summarize what is known and not known about the impact and clinical significance of variable response to antiplatelet therapy.