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Review
. 2020 Jun 4:8:2050312120929239.
doi: 10.1177/2050312120929239. eCollection 2020.

Lower extremity revascularization via endovascular and surgical approaches: A systematic review with emphasis on combined inflow and outflow revascularization

Jihad A Mustapha  1 , Bynthia M Anose  2 , Brad J Martinsen  2 , George Pliagas  3 , Joseph Ricotta  4 , Christopher W Boyes  5 , Michael S Lee  6 , Fadi Saab  1 , George Adams  7
Affiliations
Review

Lower extremity revascularization via endovascular and surgical approaches: A systematic review with emphasis on combined inflow and outflow revascularization

Jihad A Mustapha et al. SAGE Open Med. .

Abstract

This review is intended to help clinicians and patients understand the present state of peripheral artery disease, appreciate the progression and presentation of critical limb ischemia/chronic limb-threatening ischemia, and make informed decisions regarding inflow and outflow endovascular revascularization and surgical treatment options within the context of current debates in the medical community. A controlled literature search was performed to obtain research on outcomes of critical limb ischemia patients undergoing complete leg revascularization for peripheral artery disease inflow and outflow disease. Data for this review were identified by queries of medical and life science databases, expert referral, and references from relevant papers published between 1997 and 2019, resulting in 48 articles. The literature review herein indicates that endovascular revascularization-including ballooning, stenting, and atherectomy-is an effective peripheral artery disease therapy for both above the knee and below the knee disease, and can safely and effectively treat both inflow and outflow disease. As such, it plays a leading role in the therapy of lower extremity artery disease.

Keywords: Peripheral artery disease; critical limb ischemia; limb salvage; revascularization.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.A.M. has consulting agreements with Boston Scientific (BSc), Cardiovascular Systems, Inc. (CSI), Bard Peripheral Vascular (BPV), Terumo Medical, and Philips. G.P. is a consultant for CSI. C.W.B. is a lecturer for Penumbra and Cook, and an advisory committee member for BSc. G.A. has consulting agreements with BSc, CSI, Cook Medical, and Abbott Vascular. F.S. has consulting agreements with BSc, CSI, Terumo, BPV, Philips, and Medtronic. B.M.A. and B.J.M. are employees of and hold stock in CSI. M.S.L. and J.R. have no declarations of interest.

Figures

Figure 1.
Figure 1.
A controlled literature search algorithm on outcomes of patients undergoing complete leg revascularization for peripheral artery inflow and outflow disease.
Figure 2.
Figure 2.
Anatomic location of inflow, outflow, and runoff vessels.
Figure 3.
Figure 3.
Rutherford classification (RC) of peripheral artery disease and presenting pathology. RC1: mild claudication; RC2: moderate claudication; RC3: severe claudication; RC4: ischemic rest pain; RC5: minor tissue loss—nonhealing ulcer, focal gangrene with diffuse pedal ischemia; RC6: major tissue loss—extending above transmetatarsal level.
See this image and copyright information in PMC

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