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SUMMARY
Critical limb-threatening ischemia is a prevalent and comorbid condition associated with increased mortality, risk of amputation, and impaired quality of life. Revascularization is the cornerstone of management; however, it has been demonstrated that even in patients with patent femoral-distal bypass, amputation rates can be up to 15%. Pedal arch interruption was seen in almost all these patients. Pedal artery revascularization has been associated with improved wound healing and limb salvage. Further studies and registries are warranted to confirm long-term benefits and efficacy.
SUMMARY
Critical limb ischemia (CLI) is a devastating disease. This presentation will define CLI, the risk factors associated with it, and the implications it has on this patient population if left untreated.
We will highlight the possible treatment strategies with a special emphasis on endovascular treatments and new and emerging technologies available in this realm. Finally, we will look at the outcomes associated with treatment.
SUMMARY
My talk is a review of current devices and technologies for lower limb revascularization for both above and below knee therapies.
SUMMARY
Peripheral arterial disease affects nearly 20% of the population and more than 200 million people worldwide. In many cases, patients may present with lifestyle limiting claudication or critical limb ischemia (CLI). Early identification and revascularization can prevent major complications including limb loss. Advancements in endovascular technologies coupled with refinement in techniques has increased the role of endovascular therapy in treating long segment lesions despite the challenges of complex anatomy. Pedal access and retrograde arterial recanalization have become essential adjuncts to the classical antegrade approach in patients with complex patterns of lower extremity PAD. Retrograde access can significantly increase an operator’s ability to cross challenging lesions, particularly long-segment highly calcified lesions, which could not be traversed in antegrade fashion. Additionally, by choosing the site of retrograde access, controlling the extent of subintimal dissection and defining a suitable re-entry zone, the operator can limit the extent of subintimal angioplasty which has been associated with decreased long-term patency.
SUMMARY
Critical limb ischemia can be caused by complex patterns of arterial occlusive disease both above and below the knee. Contemporary endovascular treatment includes dedicated tools, techniques and strategies to optimize outcomes and prevent limb loss. Advanced skills including alternative access, pedal loop reconstruction, compartment directed revascularization and deep venous arterialization can be utilized for successful limb salvage in challenging patients.
SUMMARY
The options for management of infrainguinal peripheral arterial disease and limb revascularization has drastically changed in the last several decades. This has had a dramatic effect on the type of surgical bypass performed in the setting of a limb preservation program. Lower extremity bypass has been performed with autogenous vein as the preferred conduit. However, the complexity of surgical bypass has increased due to bypass after endovascular failure, lack of venous conduit, and poor distal arterial targets (the ‘desert foot’). This has had an impact on bypass characteristics performed at a tertiary care center with an active limb preservation program. Tibial bypass is far more common than femoral-popliteal bypass with a concomitant shift towards the use of prosthetic conduit. This shift toward prosthetic graft utilization with anastomotic adjuncts now comprise the majority of bypasses performed for limb preservation. Mastery of these techniques will be important to continue to offer bypass to patients for healing and amputation prevention.
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A discussion of what macro and micro perfusion mean and how both assessments can be utilized in a wound care practice. Multispectral imaging and near-infrared imaging will be discussed.
SUMMARY
A limb preservation center is created by offering multispeciality, multimodal care. Pillars of the center are an endovascular center and a wound care center with Hyperbaric oxygen treatment. Various support service are essential to be a true limb preservation center. The center should have the support of vascular surgeons able to do open procedures, surgical podiatrist able to do reconstructive surgery and other specialists who provide risk factor mitigation. The care should be protocol driven and be measurable.
