Revascularization for Intermittent Claudication Significantly Increases the 5-year Risk of Major Amputation in the Veterans Health Administration

Nitinol overdose—rescue of acute limb ischemia caused by stenting of the common iliac, external iliac, common femoral, superficial femoral, and popliteal arteries in an actively smoking patient with claudication

“…However, for patients with minimal symptoms, invasive therapy as the first-line treatment can prove to be more harmful than beneficial. 1 , 7 George et al 3 demonstrated that patients within the Veterans Affairs Administration healthcare system who had received intervention for claudication had three to four times the risk of future amputation than those who did not undergo intervention. They also showed that earlier intervention of IC led to faster disease progression from IC to chronic limb-threatening ischemia compared with later interventions.…”

“…They also showed that earlier intervention of IC led to faster disease progression from IC to chronic limb-threatening ischemia compared with later interventions. 3 Furthermore, according to the SVS practice guidelines, when managing multisegment disease, the proximal disease should be treated first, because such treatment might improve symptoms without needing to treat the more distal vasculature. 6 For complex asymmetric complex aortoiliac bifurcation disease, such as in our patient, Suh et al 8 have shown the benefits of unilateral stenting in reducing the overall stent number and preservation of femoral access sites for future crossover interventions.…”

“…This has been shown to lead to rapid progression to critical and acute limb ischemia (ALI), subjecting patients to invasive revascularization procedures and possible amputation. 2 , 3 Our case highlights the complications of reintervention in a patient presenting with ALI after initial endovascular intervention of her IC symptoms.…”