The role of vascular surgery in management of patients with critic chronic limb ischemia (CLI)

摘要

Introduction: During the past decade, dramatic changes have occurred in the field of endovascular management of patients with chronic critical limb ischemia (CLI). Perler and coworkers write that today, we literally have a dozen or so endovascular options for treating CLI. We can dilate it with a balloon, or dilate and cut it with cutting balloon, we can add a stent or primarily stent, with a plain old-fashioned stent, a drug eluting stent, a covered stent or even a biodegradable stent; we can cool it with cryoplasty or we can heat it with laser, or we can radiate it with brachytherapy; or we can slice it with atherectorny. We can even do a percutaneous bypass (1). Although this can be seen as a positive development, clinical studies, trying to justify each treatment modality are flawed for many reasons and the lack of evidence means that the same patient may be offered a completely different treatment depending on the clinician and the hospital. And if treatment fails, we try something else at additional cost or we refer patient to amputation surgeon with comment that everything possible was done to prevent major amputation.