Abstract
Endovascular therapy for critical limb ischemia has been used for approximately four decades. However, the data supporting its use has only recently been studied. Most of these studies support the use of endovascular therapies with equivalent outcomes to surgical revascularization. Furthermore, endovascular first approach does not compromise future surgical approaches to revascularization. Long-term follow-up of patients after revascularization is necessary, as is a multidisciplinary-team approach, for optimization of patient care and wound healing.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction: description of a new technic and a preliminary report of its applications. Circulation. 1964;30:654–70.
Dorros G, Jaff MR, Dorros AM, Mathiak LM, He T. Tibioperoneal (outflow lesion) angioplasty can be used as primary treatment in 235 patients with critical limb ischemia: five-year follow-up. Circulation. 2001;104:2057–62.
Marston WA, Davies SW, Armstrong B, Farber MA, Mendes RC, Fulton JJ, Keagy BA. Natural history of limbs with arterial insufficiency and chronic ulceration treated without revascularization. J Vasc Surg. 2006;44:108–14.
Vemulapalli S, Greiner MA, Jones WS, Patel MR, Hernandez AF, Curtis LH. Peripheral arterial testing before lower extremity amputation among medicare beneficiaries, 2000 to 2010. Circ Cardiovasc Qual Outcomes. 2014;7:142–50.
Hughes K, Seetahal S, Oyetunji T, Rose D, Greene W, Chang D, Cornwell III E, Obisesan T. Racial/ethnic disparities in amputation and revascularization: a nationwide inpatient sample study. Vasc Endovascular Surg. 2014;48:34–7.
Dieter RS, Chu WW, Pacanowski Jr JP, McBride PE, Tanke TE. The significance of lower extremity peripheral arterial disease. Clin Cardiol. 2002;25(1):3–10.
TASC II inter-society consensus on peripheral arterial disease. Eur J Vasc Endovasc Surg. 2007;33 Suppl 1:S1-75.
Dieter RS, Dieter RA Jr, Dieter RA III, editors. Peripheral arterial disease. New York: McGraw-Hill; 2009.
Dormandy J, Belcher G, Broos P, Eikelboom B, Laszlo G, Konrad P, et al. Prospective study of 713 below-knee amputations for ischaemia and the effect of a prostacyclin analogue on healing. Hawaii Study Group. Br J Surg. 1994;81(1):33–7.
Izumi Y, Satterfield K, Lee S, Harkless LB. Risk of reamputation in diabetic patients stratified by limb and level of amputation. Diabetes Care. 2006;29:566–70.
Beard JD. Which is the best revascularization for critical limb ischemia: endovascular or open surgery? J Vasc Surg. 2008;48:11S–6S.
Tartari S, Zattoni L, Rizzati R, Aliberti C, Capello K, Sacco A, Mollo F, Benea G. Subintimal angioplasty as the first-choice revascularization technique for infrainguinal arterial occlusions in patients with critical limb ischemia. Ann Vasc Surg. 2007;21:819–28.
Gray BH, Grant AA, Kalbaugh CA, Blackhurst DW, Langan 3rd EM, Taylor SA, Cull DA. The impact of isolated tibial disease on outcomes in the critical limb ischemic population. Ann Vasc Surg. 2010;24:349–59.
May KK, Robless PA, Sidhu HRS, Chua BSY, Ho P. Limb salvage in patients with peripheral arterial disease managed by endovascular first approach. Vasc Endovascular Surg. 2014;48:129–33.
Lumsden AB, Davies MG, Peden EK. Medical and endovascular management of critical limb ischemia. J Endvasc Ther. 2009;16 Suppl II:1131–62.
Graziani L, Silvestro A, Bertone V, Manara E, Andreini R, Sigala A, Mingardi R, DeGiglio R. Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. Eur J Vasc Endovasc Surg. 2007;33:453–60.
Falluji N, Mukherjee D. Critical and acute limb ischemia: an overview. Angiology. 2014;65:137–46.
Faglia E, Paola LD, Clerici G, Clerissi J, Graziani L, Fusaro M, Gabrielli L, Losa S, Stella A, Gargiulo M, Mantero M, Caminiti M, Ninkovic S, Curci V, Morabito A. Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur J Vasc Endovasc Surg. 2005;29:620–7.
Acin F, Varela C, de Maturana IL, de Haro J, Bleda S, Rodriguez-Padilla J. Results of infrapopliteal endovascular procedures performed in diabetic patients with critical limb ischemia and tissue loss from the perspective of an angiosome oriented revascularization strategy. Int J Vasc Med. 2014;2014:270539. doi: 10.1155/2014/270539. Epub 2014 Jan 6.
Kawarada O, Yasuda S, Nishimura K, Sakamoto S, Noguchi M, Takahi Y, et al. Effect of single tibial artery revascularization on microcirculation in the setting of critical limb ischemia. Circ Cardiovasc Interv. 2014 Oct;7(5):684-91. doi: 10.1161/CIRCINTERVENTIONS.113.001311. Epub 2014 Aug 19.
Gray BH, Diaz-Sandoval LJ, Dieter RS, Jaff MR, White CJ. SCAI expert consensus statement for infrapopliteal arterial intervention appropriate use. Catheter Cardiovasc Interv. 2014;84(4):539–45.
Klein AJ, Feldman DN, Aronow HD, Gray BH, Gupta K, Gigliotti OS, Jaff MR, Bersin RM, White CJ. Appropriate use criteria: a Society for Cardiovascular Angiography and Interventions (SCAI) consensus statement for aorto-iliac intervention. Catheter Cardiovasc Interv. 2014.
Dieter RS, Dieter RA, Dieter RA, editors. Endovascular interventions: a case based approach. New York: Springer; 2014.
Iida T, Iida O, Okamoto S, Dohi T, Nanto K, Uematsu M. Endovascular therapy with novel high anterior tibial artery puncture for limb salvage in a case of critical limb ischemia. Cardiovasc Interv Ther. 2014;29(4):363–7.
Montero-Baker M, Schmidt A, Bräunlich S, Ulrich M, Thieme M, Biamino G, Botsios S, Bausback Y, Scheinert D. Retrograde approach for complex popliteal and tibioperoneal occlusions. J Endovasc Ther. 2008;15:594–604.
Bolia A, Brennan J, Bell PR. Recanalisation of femoro-popliteal occlusions. Improving success rates by subintimal recanalization. Clin Radiol. 1989;40:325.
Hynes N, Mahendran B, Manning B, Andrews E, Courtney D, Sultan D. The influence of subintimal angioplasty on level of amputation and limb salvage rates in lower limb critical ischemia: a 15-year experience. Eur J Vasc Endovasc Surg. 2005;30:291–9.
Zhu YQ, Zhao JG, Liu F, Wang JB, Cheng YS, Li MH, Wang J, Li J. Subintimal angioplasty for below-the-knee arterial occlusions in diabetic patients with chronic critical limb ischemia. J Endovasc Ther. 2009;16:604–12.
Surmely JF, Tsuchikane E, Katoh O, Nishida Y, Nakayama M, Nakamura S, Oida A, Hattori E, Suzuki T. New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique. J Invasive Cardiol. 2006;18:334–8.
Kawarada O, Sakamoto S, Harada K, Ishihara M, Yasuda S, Ogawa H. Contemporary crossing techniques for infrapopliteal chronic total occlusions. J Endovasc Ther. 2014;21:266–80.
Mitsudo K, Yamashita T, Asakura Y, Muramatsu T, Doi O, Shibata Y, Morino Y. Recanalization strategy for chronic total occlusions with tapered and stiff-tip guidewire. The results of CTO new techniQUE for STandard procedure (CONQUEST) trial. J Invasive Cardiol. 2008;20:571–7.
Brennan RP. Subintimal angioplasty in critical limb ischemia: a literature review. R Coll Surg Ireland Stud Med J. 2011;4:39–45.
Met R, van Lienden KP, Koelemay MJW, Bipat S, Legemate DA, Reekers JA. Subintimal angioplasty for peripheral arterial occlusive disease: a systematic review. Cardiovsac Intervent Radiol. 2008;31:687–97.
Vraux H, Bertoncello N. Subintimal angioplasty of tibial vessel occlusions in critical limb ischemia: a good opportunity? Eur J Vasc Endovasc Surg. 2006;32:663–7.
Mendes BC, Oderich GS, Fleming MD, Misra S, Duncan AA, Kalra M, Cha S, Gloviczki P. Clinical significance of embolic events in patients undergoing endovascular femoropopliteal interventions with or without embolic protection devices. J Vasc Surg. 2014;59:359–67.
Horn-Dzijan M, Langwieser N, Groha P, Bradaric C, Linhardt M, Bottiger C, Byrne RA, Kopara T, Godel J, Hadamitzky M, Ott I, von Beckerath N, Kastrati A, Laugwitz KL, Ibrahim T. Safety and efficacy of a potential treatment algorithm by using manual compression repair and ultrasound-guided thrombin injection for the management of iatrogenic femoral artery pseudoaneurysm in a large patient cohort. Circ Cardiovasc Interv. 2014;7:207–15.
Dosluoglu HH, Lall P, Harris LM, Dryjski ML. Long-term limb salvage and survival after endovascular and open revascularization for critical limb ischemia after adoption of endovascular-first approach by vascular surgeons. J Vasc Surg. 2012;56:361–71.
Soga Y, Mii S, Lida O, Okazaki J, Kuma S, Hirano K, Suzuki K, Kawasaki D, Yamaoka T, Kamoi D, Shintani Y. Propensity score analysis of clinical outcome after bypass surgery vs. endovascular therapy for infrainguinal artery disease in patients with critical limb ischemia. J Endovasc Ther. 2014;21:243–53.
Jones WS, Dolor RJ, Hasselblad V, Vemulapalli S, Subherwal S, Schmit K, Heidenfelder B, Patel MR. Comparative effectiveness of endovascular and surgical revascularization for patients with peripheral artery disease and critical limb ischemia: systematic review of revascularization in critical limb ischemia. Am Heart J. 2014;167:489–98.
Garg K, Kaszubski PA, Moridzadeh R, Rockman CB, Adelman MA, Maldonado TS, Veith FJ, Mussa FF. Endovascular-first approach is not associated with worse amputation-free survival in appropriately selected patients with critical limb ischemia. J Vasc Surg. 2014;59:392–9.
BASIL Trial Participants. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicenter, randomized controlled trial. Lancet. 2005;366:1925–34.
Santo VJ, Dargo P, Azarbal AF, Liem TK, Mitchell EL, Landra GJ, Moneta GL. Lower extremity autologous vein bypass for critical limb ischemia is not adversely affected by prior endovascular procedure. J Vasc Surg. 2014;60:129–35.
Uhl C, Hock C, Betz T, Topel I, Steinbauer M. Pedal bypass surgery after crural endovascular intervention. J Vasc Surg. 2014;59:1583–7.
Dieter Jr RA, Kuzucz G, Dieter III RA, Dieter RS. The ORC patient/tumor classification- a new approach: a new challenge with special consideration for the lung. J Cancer Ther. 2011;2:172–5.
Varela C, Acin F, de Maturana IL, de Haro J, Bleda S, Paz B, Esparza L. Safety and efficacy outcomes of infrapopliteal endovascular procedures performed in patients with critical limb ischemia according to the Society for Vascular Surgery Objective Performance Goals. Ann Vasc Surg. 2014;28:284–94.
Wolfe JHN, Wyatt MG. Critical and subcritical ischemia. Eur J Vasc Endovsac Surg. 1997;13:578–82.
Silverberg D, Yalon T, Rimon U, Reinitz ER, Yakubovitch D, Schniderman J, Halak M. Endovascular treatment of lower extremity ischemia in chronic renal failure patients on dialysis: early and intermediate term results. IMAJ. 2013;15(12):734–8.
Fernandez N, McEnaney R, Marone LK, Rhee RY, Leers S, Makaroun M, Chaer RA. Multilevel versus isolated endovascular tibial interventions for critical limb ischema. J Vasc Surg. 2011;54:722–9.
Rocha-Singh KJ, Jaff M, Joye J, Laird J, Ansel G, Schneider P; on behalf of the VIVA Physicians. Major adverse limb events and wound healing following infrapopliteal artery stent implantation in patients with critical limb ischemia: the XCELL trial. Catheter Cardiovasc Interv. 2012;80:1042–51.
Saqib UN, Domenick N, Cho JS, Marone L, Leers S, Makaroun MS, Chaer RA. Predictors and outcomes of restenosis following tibial artery endovascular interventions for critical limb ischemia. J Vasc Surg. 2013;57:692–9.
Harries RL, Ahmed M, Whitaker C, Majeed MU, Williams DT. The influence of connective tissue disease in the management of lower extremity ischemia. Ann Vasc Surg. 2014;28:1139–42.
Dohi T, Iida O, Soga Y, Hirano K, Suzuki K, Takahara M, Uematsu M, Nanto S. Incidence, predictors, and prognosis of in-stent occlusion after endovascular treatment with nitinol stents for femoropopliteal lesions. J Vasc Surg. 2014;59:1009–15.
Chang S-H, Tsai Y-J, Chou H-H, Wu T-Y, Hsieh C-A, Cheng S-T, Huang H-L. Clinical predictors of long-term outcomes in patients with critical limb ischemia who have undergone endovascular therapy. Angiology. 2014;65:315–22.
Ryer EJ, Trocciola SM, DeRubertis B, Lam R, Hynecek RL, Karwowski J, Mureebe L, McKInsey JF, Morrissey NJ, Kent KC, Faries PL. Analysis of outcomes following failed endovascular treatment of chronic limb ischemia. Ann Vasc Surg. 2006;20:440–6.
Baumann F, Diehm N. Restenosis after infrapopliteal angioplasty- clinical importance, study update and further directions. Vasa. 2013;42:413–20.
Romiti M, Albers M, Brochado-Neto FC, Durazzo AE, Pereira CA, De Luccia N. Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg. 2008;47:975–81.
Bosiers M, Peeters P, D'Archambeau O, Hendriks J, Pilger E, Düber C, Zeller T, Gussmann A, Lohle PN, Minar E, Scheinert D, Hausegger K, Schulte KL, Verbist J, Deloose K, Lammer J. AMS INSIGHT investigators. Absorbable metal stent implantation for treatment of below-the-knee critical limb ischemia: 6-month analysis. Cardiovasc Intervent Radiol. 2009;32:424–35.
Iida O, Soga Y, Kawasaki D, Hirano K, Yamaoka T, Suzuki K, Miyashita Y, Yokoi H, Takahara M, Uematsu M. Angiographic restenosis and its clinical impact after infrapopliteal angioplasty. Eur J Vasc Endovasc Surg. 2012;44:425–31.
Lo RC, Darling J, Bensley RP, Giles KA, Dahlberg SE, Hamdan AD, Wyers M, Schermerhorn ML. Outcomes following infrapopliteal angioplasty for critical limb ischemia. J Vasc Surg. 2013;57:1455–63.
Lee JJ, Katz SG. The number of patent tibial vessels does not influence primary patency after nitinol stenting of the femoral and popliteal arteries. J Vasc Surg. 2012;55:994–1000.
Hiramori S, Soga Y, Tomoi Y, Tosaka A. Impact of runoff grade after endovascular therapy for femoropopliteal lesions. J Vasc Surg. 2014;59:720–7.
Georgakarakos E, Papanas N, Papadaki E, Georgiadis GS, Maltezos E, Lazarides MK. Endovascular treatment of critical ischemia in the diabetic foot: new thresholds, new anatomies. Angiology. 2012;64:583–91.
Lazaris AM, Salas C, Tsiamis AC, Vlachou PA, Bolia A, Fishwick G, Bell PR. Factors affecting patency of subintimal infrainguinal angioplasty in patients with critical limb ischemia. Eur J Vasc Endovasc Surg. 2006;32:668–74.
Daryapeyma A, Ostlund O, Wahlgren CM. Healthcare associated infections after lower extremity revasculzarization. Eur J Vasc Endovasc Surg. 2014;48:72–7.
Gandini R, Angelopoulos G, Da Ros V, Simonetti G. Percutaneous transluminal angioplasty for treatment of critical hand ischemia with a novel endovascular approach: “the radial to ulnar artery loop technique.”. J Vasc Surg. 2010;51:760–2.
Kawarada O, Yokoi Y, Higashimori A. Angioplasty of ulnar or radial arteries to treat critical hand ischemia: use of 3- and 4-French systems. Catheter Cardiovasc Interv. 2010;76:345–50.
Fergus T, Pacanowski Jr JP, Dieter RS, et al. Subclavian-coronary steal: diagnosis and treatment. Angiology. 2007;58:372–5.
Nasser F, Cavalcante RN, Galastri FL, de Amorim EJ, Telles MAP, Travassos FB, De Fina B, Affonso BB. Endovascular stenting of brachial artery occlusion in critical hand ischemia. Ann Vasc Surg. 2014;28:1564e1-3.
Saarinen E, Laukontaus SJ, Alback A, Venermo M. Duplex surveillance after endovascular revascularization for critical limb ischemia. Eur J Vasc Endovasc Surg. 2014;47:418–21.
Wakassa TB, Benabou JE, Puech-Leao P. Clinical efficacy of successful angioplasty in critical ischemia—a cohort study. Ann Vasc Surg. 2014;28:143–1148.
Robertson L, Ghouri MA, Kovacs F. Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment (review). Cochrane Database Syst Rev. 2012; issue 8. Art no.:CD002071. doi:10.1002/14651858.CD002071.pub3
Kavros SJ, Delis KT, Turner NS, Voll AE, Liedl DA, Gloviczki P, Rooke TW. Improving limb salvage in critical ischemia with intermittent pneumatic compression: a controlled study with 18 month follow up. J Vasc Surg. 2008;47:543–9.
Van Gils CC, Wheeler LA, Mellstrom M, Brinton EA, Mason S, Wheeler CG. Amputation prevention by vascular surgery and podiatry collaboration in high-risk diabetic and nondiabetic patients. Diabetes Care. 1999;22:678–83.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Dieter, R.S. (2017). Principles of Endovascular Treatment of Critical Limb Ischemia. In: Dieter, R., Dieter, Jr, R., Dieter, III, R., Nanjundappa, A. (eds) Critical Limb Ischemia. Springer, Cham. https://doi.org/10.1007/978-3-319-31991-9_34
Download citation
DOI: https://doi.org/10.1007/978-3-319-31991-9_34
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-31989-6
Online ISBN: 978-3-319-31991-9
eBook Packages: MedicineMedicine (R0)