Vaskulárna medicína 2/2020

Current procedures and overview of endovascular techniques in the treatment of critical limb ischemia

Peripheral arterial disease is a chronic vascular disease characterized by impaired circulation to the lower extremities. Its advanced stage, known as critical limb ischemia (CLI), puts patients at an increased risk of cardiovascular events, amputation, and death with serious clinical manifestation including ischemic rest pain, arterial insufficiency ulcers, and gangrene. Amputation rates are unacceptably high especially among patients suffering with diabetes mellitus. In addition, advanced arterial disease is risky in terms of in situ thrombotic obliteration, based on sudden atherothrombotic event, with subsequent development of acute limb ischemia (ALI). Underdiagnosed and untreated acute arterial occlusion can quickly progress to infarction and loss of limb and life of the patient. In this article, we want to highlight the main benefits of mini-invasive endovascular treatment (EVT) as an firstline, effective and safe revascularization strategy. Progress in the field of EVT gives us new opportunities to effectively treat lower limb arterial disease (CLI and ALI), at our workplace. The goal of EVL is to remove / modify the atherosclerotic plaque, revascularize occlusion or extract acute thrombi from the arterial bed, so that the blood supply to the periphery of the limb is supplied with oxygen and nutrients. For this purpose, new techniques and strategies have become increasingly prominent in EVL CLI and ALI in recent years, such as special “reinforced” balloons, “drug-releasing” technologies for balloons and stents, various types of atherectomy, or lithotripsy. The aim is to improve the immediate effect of EVL, prolong the long-term patency of the arteries, support the healing of defects and thus preserve the limb.

Keywords: peripheral arterial disease, critical limb ischemia, endovascular treatment