Managing patients with critical limb ischemia is very difficult. Beyond the clinical difficulties, clinicians need high quality data to help drive decisions. Unfortunately, most data out there are low quality. Also, assessing critical limb ischemia outcomes is not straightforward. Still, two major trials, BEST-CLI and BASIL 2 stand out. These are randomized trials in critical…
Cilostazol has been around for a long time. Still, we don’t know enough about it. In any case, many potential effects of cilostazol make sense for patients with peripheral artery disease in general and critical limb ischemia in particular. The brand name in the United States is Pletal. How does Cilostazol Work? As I wrote…
Critical limb ischemia is the most advanced form of peripheral artery disease. So, one would think that the leg pain that these patients experience is simply severe ischemic pain. However, it turns out that the truth is more complicated. Pain in critical limb ischemia is a combination of nociceptive pain and of neuropathic pain. Each…
Estimating procedural outcomes relies on both patient and procedural features. Many critical limb ischemia (CLI) patients will not achieve clinical improvement despite a successful intervention [ref]. The converse is also true: limb salvage rates may exceed arterial patency rates in certain patients [ref]. Thus, we need to take into account factors other than traditional medical…
Critical limb ischemia is the most severe form of peripheral artery disease. Critical limb ischemia patients have rest pain, non-healing ulcers or gangrene. Often, patients who develop critical limb ischemia are medically complex. They often frail and more often than not have multiple co-morbid conditions. Thus, critical limb ischemia is a complicated condition to treat…
Critical limb ischemia is the most severe form of peripheral artery disease. Patients suffer from rest pain, loss of tissue or gangrene. Left unchecked, critical limb ischemia can lead to amputation. Patients can lose toes or even a limb. Deciding about amputation in critical limb ischemia patients is not always easy. Also, choosing the optimal…
There is a need for more clinical trial data to facilitate medical decision making when caring for patients with critical limb ischemia (CLI). Traditionally, outcome assessment in clinical trials for this patient population has focused on amputation-free survival and patency. Choosing the optimal outcome that is important to patients with CLI and their providers will…
Wound healing in critical limb ischemia often requires improving blood flow to the wound. Angiosomes are areas of the foot supplied by separate arteries. The angiosome theory claims that improving wound healing requires angiosome specific revascularization. Per this theory non-angiosome revascularization isn’t enough. Critical limb ischemia is ischemic rest pain and / or nonhealing wounds…
An angiosome is a three-dimensional anatomic sector of the human body that is perfused by a single source artery (1). Each angiosome is connected to surrounding angiosomes through “choke vessels” that may become important when the perfusion capacity from the source artery is diminished. Appropriate perfusion becomes crucial in patients with critical limb ischemia. What…
