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Semin intervent Radiol 2014; 31(04): 300-306
DOI: 10.1055/s-0034-1393965
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Contemporary Treatment for Critical Ischemia: The Evidence for Interventional Radiology or Surgery

Keith Hussey
1   Department of Vascular Surgery, Western Infirmary of Glasgow, Glasgow, Scotland, United Kingdom
,
Sivanathan Chandramohan
2   Department of Radiology, Western Infirmary of Glasgow, Glasgow, Scotland, United Kingdom
› Author Affiliations
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Publication History

Publication Date:
14 November 2014 (online)

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Abstract

This article is a review of the evidence regarding the management of patients with critical limb ischemia. The aim of the study is to discuss the definition, incidence, and clinical importance of critical limb ischemia, as well as the aims of treatment in terms of quality of life and limb salvage. Endovascular and surgical treatments should not be viewed as competing therapies. In fact, these are complementary techniques each with strengths and weaknesses. The authors will propose a strategy based on the available evidence for deciding the optimal approach to management of patients with critical limb ischemia.

Keywords

interventional radiology - critical limb ischemia - peripheral arterial disease - surgery
 

  • References

  • 1 Fowkes FGR, Housley E, Cawood EHA, Macintyre CCA, Ruckley CV, Prescott RJ. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 1991; 20 (2) 384-392
    CrossrefPubMedSearch in Google Scholar
  • 2 European Working Group on Critical Limb Ischemia. Second European Consensus Document on chronic critical leg ischemia. Eur J Vasc Surg 1992; 6 (Suppl A): 1-32
    PubMedSearch in Google Scholar
  • 3 Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG ; TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007; 45 (Suppl S): S5-S67
    CrossrefPubMedSearch in Google Scholar
  • 4 National Institute for Health and Clinical Excellence. Lower Limb Peripheral Arterial Disease: Diagnosis and Management. NICE clinical guideline 147; 2012 . Available at: guidance.nice.org.uk/cg147
    PubMedSearch in Google Scholar
  • 5 Pell JP, Whyman MR, Fowkes FGR, Gillespie I, Ruckley CV. Trends in vascular surgery since the introduction of percutaneous transluminal angioplasty. Br J Surg 1994; 81 (6) 832-835
    CrossrefPubMedSearch in Google Scholar
  • 6 Nasr MK, McCarthy RJ, Hardman J, Chalmers A, Horrocks M. The increasing role of percutaneous transluminal angioplasty in the primary management of critical limb ischaemia. Eur J Vasc Endovasc Surg 2002; 23 (5) 398-403
    CrossrefPubMedSearch in Google Scholar
  • 7 Kudo T, Chandra FA, Kwun WH, Haas BT, Ahn SS. Changing pattern of surgical revascularization for critical limb ischemia over 12 years: endovascular vs. open bypass surgery. J Vasc Surg 2006; 44 (2) 304-313
    CrossrefPubMedSearch in Google Scholar
  • 8 Nowygrod R, Egorova N, Greco G , et al. Trends, complications, and mortality in peripheral vascular surgery. J Vasc Surg 2006; 43 (2) 205-216
    CrossrefPubMedSearch in Google Scholar
  • 9 Adam DJ, Beard JD, Cleveland T , et al; BASIL trial participants. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 2005; 366 (9501) 1925-1934
    CrossrefPubMedSearch in Google Scholar
  • 10 van der Zaag ES, Legemate DA, Prins MH, Reekers JA, Jacobs MJ. Angioplasty or bypass for superficial femoral artery disease? A randomised controlled trial. Eur J Vasc Endovasc Surg 2004; 28 (2) 132-137
    CrossrefPubMedSearch in Google Scholar
  • 11 Dick F, Diehm N, Galimanis A, Husmann M, Schmidli J, Baumgartner I. Surgical or endovascular revascularization in patients with critical limb ischemia: influence of diabetes mellitus on clinical outcome. J Vasc Surg 2007; 45 (4) 751-761
    CrossrefPubMedSearch in Google Scholar
  • 12 Bradbury A, Wilmink T, Lee AJ , et al. Bypass versus angioplasty to treat severe limb ischemia: factors that affect treatment preferences of UK surgeons and interventional radiologists. J Vasc Surg 2004; 39 (5) 1026-1032
    CrossrefPubMedSearch in Google Scholar
  • 13 Holm J, Arfvidsson B, Jivegård L , et al. Chronic lower limb ischaemia. A prospective randomised controlled study comparing the 1-year results of vascular surgery and percutaneous transluminal angioplasty (PTA). Eur J Vasc Surg 1991; 5 (5) 517-522
    CrossrefPubMedSearch in Google Scholar
  • 14 Bradbury AW, Adam DJ, Bell J , et al; BASIL trial Participants. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg 2010; 51 (5, Suppl): 5S-17S
    PubMedSearch in Google Scholar
  • 15 Dearing DD, Patel KR, Compoginis JM, Kamel MA, Weaver FA, Katz SG. Primary stenting of the superficial femoral and popliteal artery. J Vasc Surg 2009; 50 (3) 542-547
    CrossrefPubMedSearch in Google Scholar
  • 16 Rogers JH, Laird JR. New drugs and technologies—overview of new technologies for lower extremity revascularisation. Circulation 2007; 116: 2072-2085
    CrossrefPubMedSearch in Google Scholar
  • 17 Desgranges P, Boufi M, Lapeyre M , et al. Subintimal angioplasty: feasible and durable. Eur J Vasc Endovasc Surg 2004; 28 (2) 138-141
    CrossrefPubMedSearch in Google Scholar
  • 18 Al-Omran M, Tu JV, Johnston KW, Mamdani MM, Kucey DS. Outcome of revascularization procedures for peripheral arterial occlusive disease in Ontario between 1991 and 1998: a population-based study. J Vasc Surg 2003; 38 (2) 279-288
    CrossrefPubMedSearch in Google Scholar
  • 19 Wilson SE, Wolf GL, Cross AP. Percutaneous transluminal angioplasty versus operation for peripheral arteriosclerosis. Report of a prospective randomized trial in a selected group of patients. J Vasc Surg 1989; 9 (1) 1-9
    PubMedSearch in Google Scholar
  • 20 Ah Chong AK, Tan CB, Wong MW, Cheng FS. Bypass surgery or percutaneous transluminal angioplasty to treat critical lower limb ischaemia due to infrainguinal arterial occlusive disease?. Hong Kong Med J 2009; 15 (4) 249-254
    PubMedSearch in Google Scholar
  • 21 Burke CR, Henke PK, Hernandez R , et al. A contemporary comparison of aortofemoral bypass and aortoiliac stenting in the treatment of aortoiliac occlusive disease. Ann Vasc Surg 2010; 24 (1) 4-13
    CrossrefPubMedSearch in Google Scholar
  • 22 McQuade K, Gable D, Pearl G, Theune B, Black S. Four-year randomized prospective comparison of percutaneous ePTFE/nitinol self-expanding stent graft versus prosthetic femoral-popliteal bypass in the treatment of superficial femoral artery occlusive disease. J Vasc Surg 2010; 52 (3) 584-590 , discussion 590–591, e1, e7
    CrossrefPubMedSearch in Google Scholar
  • 23 Scali ST, Rzucidlo EM, Bjerke AA , et al. Long-term results of open and endovascular revascularization of superficial femoral artery occlusive disease. J Vasc Surg 2011; 54 (3) 714-721
    CrossrefPubMedSearch in Google Scholar
  • 24 Siracuse JJ, Giles KA, Pomposelli FB , et al. Results for primary bypass versus primary angioplasty/stent for intermittent claudication due to superficial femoral artery occlusive disease. J Vasc Surg 2012; 55 (4) 1001-1007
    CrossrefPubMedSearch in Google Scholar
  • 25 Korhonen M, Biancari F, Söderström M , et al. Femoropopliteal balloon angioplasty vs. bypass surgery for CLI: a propensity score analysis. Eur J Vasc Endovasc Surg 2011; 41 (3) 378-384
    CrossrefPubMedSearch in Google Scholar
  • 26 Ihnat DM, Duong ST, Taylor ZC , et al. Contemporary outcomes after superficial femoral artery angioplasty and stenting: the influence of TASC classification and runoff score. J Vasc Surg 2008; 47 (5) 967-974
    CrossrefPubMedSearch in Google Scholar
  • 27 Feinglass J, Pearce WH, Martin GJ , et al. Postoperative and amputation-free survival outcomes after femorodistal bypass grafting surgery: findings from the Department of Veterans Affairs National Surgical Quality Improvement Program. J Vasc Surg 2001; 34 (2) 283-290
    CrossrefPubMedSearch in Google Scholar
  • 28 Mousa A, Abdel-Hamid M, Ewida A, Saad M, Sahrabi A. Combined percutaneous endovascular iliac angioplasty and infrainguinal surgical revascularization for chronic lower extremity ischemia: preliminary result. Vascular 2010; 18 (2) 71-76
    CrossrefPubMedSearch in Google Scholar
  • 29 Dosluoglu HH, Lall P, Cherr GS, Harris LM, Dryjski ML. Role of simple and complex hybrid revascularization procedures for symptomatic lower extremity occlusive disease. J Vasc Surg 2010; 51 (6) 1425-1435 , e1
    CrossrefPubMedSearch in Google Scholar
  • 30 Piazza M, Ricotta II JJ, Bower TC , et al. Iliac artery stenting combined with open femoral endarterectomy is as effective as open surgical reconstruction for severe iliac and common femoral occlusive disease. J Vasc Surg 2011; 54 (2) 402-411
    CrossrefPubMedSearch in Google Scholar
  • 31 Schneider PA, Caps MT, Ogawa DY, Hayman ES. Intraoperative superficial femoral artery balloon angioplasty and popliteal to distal bypass graft: an option for combined open and endovascular treatment of diabetic gangrene. J Vasc Surg 2001; 33 (5) 955-962
    CrossrefPubMedSearch in Google Scholar
  • 32 Schanzer A, Owens CD, Conte MS, Belkin M. Superficial femoral artery percutaneous intervention is an effective strategy to optimize inflow for distal origin bypass grafts. J Vasc Surg 2007; 45 (4) 740-743
    CrossrefPubMedSearch in Google Scholar
  • 33 Lantis J, Jensen M, Benvenisty A, Mendes D, Gendics C, Todd G. Outcomes of combined superficial femoral endovascular revascularization and popliteal to distal bypass for patients with tissue loss. Ann Vasc Surg 2008; 22 (3) 366-371
    CrossrefPubMedSearch in Google Scholar
  • 34 Gray BH, Grant AA, Kalbaugh CA , et al. The impact of isolated tibial disease on outcomes in the critical limb ischemic population. Ann Vasc Surg 2010; 24 (3) 349-359
    CrossrefPubMedSearch in Google Scholar
  • 35 Varty K, Bolia A, Naylor AR, Bell PRF, London NJM. Infrapopliteal percutaneous transluminal angioplasty: a safe and successful procedure. Eur J Vasc Endovasc Surg 1995; 9 (3) 341-345
    CrossrefPubMedSearch in Google Scholar
  • 36 Nydahl S, Hartshorne T, Bell PRF, Bolia A, London NJM. Subintimal angioplasty of infrapopliteal occlusions in critically ischaemic limbs. Eur J Vasc Endovasc Surg 1997; 14 (3) 212-216
    CrossrefPubMedSearch in Google Scholar
  • 37 Clair DG, Dayal R, Faries PL , et al. Tibial angioplasty as an alternative strategy in patients with limb-threatening ischemia. Ann Vasc Surg 2005; 19 (1) 63-68
    CrossrefPubMedSearch in Google Scholar
  • 38 Atar E, Siegel Y, Avrahami R, Bartal G, Bachar GN, Belenky A. Balloon angioplasty of popliteal and crural arteries in elderly with critical chronic limb ischemia. Eur J Radiol 2005; 53 (2) 287-292
    CrossrefPubMedSearch in Google Scholar
  • 39 Söder HK, Manninen HI, Jaakkola P , et al. Prospective trial of infrapopliteal artery balloon angioplasty for critical limb ischemia: angiographic and clinical results. J Vasc Interv Radiol 2000; 11 (8) 1021-1031
    CrossrefPubMedSearch in Google Scholar
  • 40 Iida O, Soga Y, Yamauchi Y , et al. Clinical efficacy of endovascular therapy for patients with critical limb ischemia attributable to pure isolated infrapopliteal lesions. J Vasc Surg 2013; 57 (4) 974-981 , e1
    CrossrefPubMedSearch in Google Scholar
  • 41 Pomposelli Jr FB, Marcaccio EJ, Gibbons GW , et al. Dorsalis pedis arterial bypass: durable limb salvage for foot ischemia in patients with diabetes mellitus. J Vasc Surg 1995; 21 (3) 375-384
    CrossrefPubMedSearch in Google Scholar
  • 42 Kalra M, Gloviczki P, Bower TC , et al. Limb salvage after successful pedal bypass grafting is associated with improved long-term survival. J Vasc Surg 2001; 33 (1) 6-16
    CrossrefPubMedSearch in Google Scholar
  • 43 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 (5) 975-981
    CrossrefPubMedSearch in Google Scholar
  • 44 Schamp KB, Meerwaldt R, Reijnen MM, Geelkerken RH, Zeebregts CJ. The ongoing battle between infrapopliteal angioplasty and bypass surgery for critical limb ischemia. Ann Vasc Surg 2012; 26 (8) 1145-1153
    CrossrefPubMedSearch in Google Scholar
  • 45 Casella IB, Brochado-Neto FC, Sandri GdeA , et al. Outcome analysis of infrapopliteal percutaneous transluminal angioplasty and bypass graft surgery with nonreversed saphenous vein for individuals with critical limb ischemia. Vasc Endovascular Surg 2010; 44 (8) 625-632
    CrossrefPubMedSearch in Google Scholar
  • 46 Liistro F, Porto I, Angioli P , et al. Drug-eluting balloon in peripheral intervention for below the knee angioplasty evaluation (DEBATE-BTK): a randomized trial in diabetic patients with critical limb ischemia. Circulation 2013; 128 (6) 615-621
    CrossrefPubMedSearch in Google Scholar
  • 47 Spiliopoulos S, Fragkos G, Katsanos K, Diamantopoulos A, Karnabatidis D, Siablis D. Long-term outcomes following primary drug-eluting stenting of infrapopliteal bifurcations. J Endovasc Ther 2012; 19 (6) 788-796
    CrossrefPubMedSearch in Google Scholar
  • 48 Rocha-Singh KJ, Jaff M, Joye J, Laird J, Ansel G, Schneider P ; 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 (6) 1042-1051
    CrossrefPubMedSearch in Google Scholar
  • 49 Landry GJ. Functional outcome of critical limb ischemia. J Vasc Surg 2007; 45 (6, Suppl A): A141-A148
    CrossrefPubMedSearch in Google Scholar
  • 50 Goshima KR, Mills Sr JL, Hughes JD. A new look at outcomes after infrainguinal bypass surgery: traditional reporting standards systematically underestimate the expenditure of effort required to attain limb salvage. J Vasc Surg 2004; 39 (2) 330-335
    CrossrefPubMedSearch in Google Scholar
  • 51 Taylor SM, Kalbaugh CA, Blackhurst DW , et al. Determinants of functional outcome after revascularization for critical limb ischemia: an analysis of 1000 consecutive vascular interventions. J Vasc Surg 2006; 44 (4) 747-755 , discussion 755–756
    CrossrefPubMedSearch in Google Scholar
  • 52 Nguyen LL, Moneta GL, Conte MS, Bandyk DF, Clowes AW, Seely BL ; PREVENT III Investigators. Prospective multicenter study of quality of life before and after lower extremity vein bypass in 1404 patients with critical limb ischemia. J Vasc Surg 2006; 44 (5) 977-983 , discussion 983–984
    CrossrefPubMedSearch in Google Scholar
  • 53 Holtzman J, Caldwell M, Walvatne C, Kane R. Long-term functional status and quality of life after lower extremity revascularization. J Vasc Surg 1999; 29 (3) 395-402
    CrossrefPubMedSearch in Google Scholar
  • 54 van Overhagen H, Spiliopoulos S, Tsetis D. CIRSE Standards of Practice Guidelines: below the knee interventions. Cardiovasc Intervent Radiol 2013; 36: 302-311
    CrossrefPubMedSearch in Google Scholar