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The Long-Term Care of Patients with Critical Limb Ischemia (CLI)

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Critical Limb Ischemia

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Abstract

Critical limb ischemia (CLI) is the end stage of peripheral artery disease (PAD). It encompasses <5 % of all cases of PAD, but its prognosis is poor. The 1-year mortality and major amputation rates range from 20 to 50 %. The treatment of the patient with CLI is complex. Its foundation is based on the development of three pillars, each of which represents diverse aspects and goals of therapy: medical, interventional, and surveillance. Medical management has a role in the treatment of risk factors for secondary prevention of cardiovascular disease, with a less established role in the treatment of symptoms and complications of severe limb hypoperfusion. Pharmacological agents may also have a role as adjuncts or alternatives in patients who are unsuitable for revascularization or those who have suboptimal results. Interventional therapies (surgical and endovascular) are the mainstay form of treatment in CLI and are directed to achieve revascularization, symptom control, wound healing, and limb salvage. Last but not least, the surveillance pillar of treatment is the one that is currently least well represented and represents the Achilles heel of contemporary CLI care, as most patients do not have a rigorous follow-up. It is intended to provide close follow-up and monitoring after revascularization and healing. At the first sign of decline or evidence of stalled progress, the patient should once again be promptly referred to the CLI team and the continuum of care reinitiated. Future directions include the development of biological therapies based on the use of growth factors, gene therapy, and stem cells, which are currently being investigated.

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Authors and Affiliations

  1. Department of Medicine, Metro Health Hospital, Michigan State University, Wyoming, MI, USA

    Larry J. Diaz-Sandoval MD

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  1. Larry J. Diaz-Sandoval MD
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Editors and Affiliations

  1. Loyola University Medical Center, Maywood, Illinois, USA

    Robert S. Dieter

  2. Northwestern Medicine Central DuPage Hospital, Glen Ellyn, Illinois, USA

    Raymond A. Dieter, Jr

  3. The University of Tennessee Medical Center, Knoxville, Tennessee, USA

    Raymond A. Dieter, III

  4. West Virginia University, Charleston, West Virginia, USA

    Aravinda Nanjundappa

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Diaz-Sandoval, L.J. (2017). The Long-Term Care of Patients with Critical Limb Ischemia (CLI). 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_58

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