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Arterial Revascularization

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Limb Preservation for the Vascular Specialist

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Abstract

A large proportion of patients in the stages of limb preservation suffer from peripheral arterial disease (PAD), which also is an important cause of cardiovascular morbidity and mortality, with increasing prevalence throughout the world. PAD is due to narrowing/occlusion of the arteries, particularly in the lower extremities, and can cause patients with rest pain or non-healing wounds to progress rapidly to major amputation, which carries a significantly high mortality rate. This is seen most commonly in patients with diabetes, renal failure, history of smoking, and hypertension and hypercholesterolemia. Prompt identification of patients with PAD, and specifically CLI/CLTI, followed by appropriate and aggressive revascularizations can help prevent major amputation. Over the decades, revascularization options have progressed from surgical options only, to now more often endovascular approaches. Notably, there has been a rapid increase in the development of new endovascular tools, techniques, and medical therapies for PAD. In this chapter, we discuss in detail both updated surgical and endovascular interventions from aortoiliac to pedal disease, including management of patients previously considered “no option.”

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Author information

Authors and Affiliations

  1. Department of Interventional Cardiology, Mount Sinai Hospital, New York, NY, USA

    Ibrahim Ali, Uman Jaffer & Prakash Krishnan

  2. Department of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, IL, USA

    Bulent Arslan, Sreekumar Madassery, Murat Osman, Rehan Riaz, David M. Tabriz & Omar M. Uddin

  3. Palm Vascular Centers, Fort Lauderdale, FL, USA

    Robert Beasley

  4. Department of Surgery, Division of Vascular Surgery, Loyola University Medical Center, Hines, IL, USA

    Carlos Bechara

  5. Department of Surgery, Division of Vascular and Endovascular Surgery, Stanford Medicine, Palo Alto, CA, USA

    Pauline Berens & Venita Chandra

  6. Great Lakes Medical Imaging, Williamsville, NY, USA

    Omar Chohan

  7. Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada

    Claudia Cote

  8. Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Farnaz Dadrass, Ricki A. Korff, Robert A. Lookstein & Raghuram Posham

  9. Los Angeles Imaging and Interventional Consultants, Los Angeles, CA, USA

    Sabeen Dhand

  10. Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Anahita Dua

  11. Lakeland Vascular Institute, Lakeland, FL, USA

    Fakhir Elmasri & Venkat Tummala

  12. HCA Healthcare Tristar Division, The Surgical Clinic PLLC, Nashville, TN, USA

    Bryan Fischer

  13. Department of Internal Medicine, Ochsner Health System, New Orleans, LA, USA

    Ahmad Omar Hallak

  14. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Daniel K. Han

  15. Advanced Cardiac and Vascular Centers, New York, NY, USA

    Carmen Heaney, Abigail Mize, Jihad A. Mustapha & Fadi A. Saab

  16. Advanced Interventional & Vascular Services LLP, New York, NY, USA

    Kevin Herman & John H. Rundback

  17. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Samuel Jessula

  18. Department of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, USA

    Ahmed Kayssi

  19. Department of Radiology, Division of Interventional Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Nicole Keefe, Maureen Kohi, Gloria Salazar & Jordan Taylor

  20. Vascular& Interventional Specialists of Siouxland, Dakota, SD, USA

    Neal Khurana & Chad Laurich

  21. Department of Radiology, Division of Vascular and Interventional Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA

    Abhishek Kumar

  22. Department of Surgery, Division of Vascular Surgery, Rush University Medical Center, Chicago, IL, USA

    Alison Maringo, Mohamed Nagi & Michele Richard

  23. Department of Radiology, Division of Interventional Radiology, Maine Medical Center, Portland, ME, USA

    Jesse Martin

  24. Department of Interventional Cardiology, Bradenton Cardiology Center, Manatee Memorial Hospital, Bradenton, FL, USA

    S. Jay Mathews

  25. Ochsner Health System, New Orleans, LA, USA

    Reuben Perez McCon

  26. Department of Interventional Radiology, University of Miami Health System, UM Miller School of Medicine, Miami, FL, USA

    Ankit Mehta & Srini Tummala

  27. CardioVascular Health Clinic, Miami, FL, USA

    Jim G. Melton & Blake P. Parsons

  28. Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA

    Jorge Miranda

  29. HOPE Vascular and Podiatry Institute, Houston, TX, USA

    Miguel Montero Baker

  30. Department of Cardiology, Ochsner Health System, New Orleans, LA, USA

    Zola N’Dandu

  31. Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA

    Aishwarya Raja

  32. Miami Cardiac and Vascular Institute, Miami, FL, USA

    Brian J. Schiro

  33. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Eric Secemsky

  34. Advanced Vascular Centers, Boston, MA, USA

    Jill Sommerset

  35. Mercy Clinic Heart and Vascular LLC, St. Louis, MO, USA

    Anish Thomas

  36. Department of Interventional Radiology, Centro Vascolare Ticino, Ospedale Regionale di Lugano, Sede Civico, Lugano, Switzerland

    Jos Van Den Berg

  37. Atlantic Medical Imaging, Pleasantville, NJ, USA

    Micah Watts

  38. Vascular & Interventional Physicians, Pleasantville, NJ, USA

    Bret N. Wiechmann

  39. Department of Vascular and Endovascular Surgery, Hospital Universitario Cruces, Bizkaia, Spain

    August Ysa

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  1. Ibrahim Ali
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  2. Bulent Arslan
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Editor information

Editors and Affiliations

  1. Rush University Medical Center, Chicago, IL, USA

    Sreekumar Madassery

  2. Rush University Medical Center, Chicago, IL, USA

    Aesha Patel

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Ali, I. et al. (2023). Arterial Revascularization. In: Madassery, S., Patel, A. (eds) Limb Preservation for the Vascular Specialist. Springer, Cham. https://doi.org/10.1007/978-3-031-36480-8_6

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