Angioplasty for treatment of isolated below-the-knee arterial stenosis in patients with critical limb ischemia.

摘要

In this issue of the journal Mendiz et al describe a large series of below knee angioplasty procedures in patients with critical limb ischemia (CLI) and reach the conclusion that this approach represents a safe and effective treatment option. Their technical results are good although there was no direct comparison with surgical bypass. In reality, there is very little level 1 evidence comparing endoarterial revascularization with bypass surgery for patients with severe lower limb ischemia. Consequently, there remains a lack of clarity as to how we should select treatment for individual patients. This issue is particularly important in diabetics where arteries proximal to the knee joint are often spared from occlusive disease and the majority of occlusions occur distal to the tibial bifurcation. Besides relieving pain and healing neuroischemic ulcers, the most important outcome in these patients is amputation-free survival.