Critical limb ischemia: an update for interventional radiologists

Abstract

Critical limb ischemia (CLI) is a growing epidemic with bleak patient outcomes. A variety of treatment modalities have been adopted to address CLI based on comorbidities, life expectancy, and the nature of the arterial disease. With advances in technology and treatment strategies, the clinical outcomes of CLI patients have significantly improved over recent years. However, despite progress, patency rates of both surgical and endovascular interventions, limb-salvage and amputation rates are still dismal. We review the epidemiology, treatment strategies, imaging modalities, and the microcirculation aspect of CLI.

Contrast induced‐acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media: A meta‐analysis and systematic review of current literature

“…As the prevalence of diabetes, CKD, and peripheral arterial disease (PAD) continues to rise, an increasing number of patients will present for endovascular therapy and be exposed to the risk of CI‐AKI . The use of digital subtraction imaging with ICM remains the most common angiographic approach in patients with symptomatic PAD .…”

Lower Extremity Arterial Duplex, Toe-Brachial Index, and Computed Tomography Angiography Examinations in Peripheral Arterial Disease: A Case Presentation

“…10 It is important to remember that CLI develops in approximately 1% of all PAD cases. 11 Critical limb ischemia is associated with a greater risk for cardiac ischemic events, leading to increased morbidity and mortality rates from coronary artery disease. One of the diagnostic criteria for CLI is toe pressure < 30 mmHg.…”

Current Status of Arterial Revascularization for the Treatment of Critical Limb Ischemia in Infrainguinal Atherosclerotic Disease

“…Based upon this study of operable cases, just those patients with life expectancies higher than 2 years are likely to realize a survival benefit from surgery compared with endovascular option. 49,50,54 Taha et al 51 evaluated the comparative effectiveness of endovascular versus surgical revascularization for acute lower extremity ischemia, and they found similar limb salvage rates between the groups while significantly higher mortality rates in the open surgical revascularization group. Ohmine et al assessed the comparative efficacy and durability of endovascular therapy or bypass surgery as a first approach for the treatment of CLI due to infragenicular lesions, and they concluded that the endovascular therapy-first option was more effective and durable especially for patients who were in poor general condition or whose saphenous veins were in poor condition.…”