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Review
. 2022 May;24(5):513-517.
doi: 10.1007/s11886-022-01669-6. Epub 2022 Feb 22.

Novel Therapies for Critical Limb-Threatening Ischemia

Ashkan Karimi  1 , Alexis L Lauria  2 , Behdad Aryavand  3 , Richard F Neville  4
Affiliations
Review

Novel Therapies for Critical Limb-Threatening Ischemia

Ashkan Karimi et al. Curr Cardiol Rep. 2022 May.

Abstract

Purpose of review: This review intends to discuss the latest endovascular and surgical advancement in the treatment of critical limb-threatening ischemia (CLTI).

Recent findings: We discuss novel endovascular technological advancements such as intravascular lithotripsy, the Tack endovascular stent, the PQ Bypass DETOUR system, and the LimFlow System for deep venous arterialization (DVA) in the very high risk "no-option" CLTI population. We also discuss the increasing adoption of radial and pedal approaches for endovascular revascularization and the tibiopedal arterial minimally invasive (TAMI) technique. On the surgical front, we discuss the distal vein patch technique and surgical and hybrid DVA. Recent advancements in the treatment options of CLTI will likely lead to reducing the rate of major amputations if they are adopted in a collaborative environment in order to apply the most appropriate treatment option to each individual patient based on the anatomy, comorbidities, functional status, and local expertise.

Keywords: Chronic limb-threatening ischemia; Deep venous arterialization; Peripheral arterial disease.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
    1. • Mustapha JA, Katzen BT, Neville RF, Lookstein RA, Zeller T, Miller LE, et al. Determinants of long-term outcomes and costs in the management of critical limb ischemia: a population-based cohort study. J Am Heart Assoc. 2018;7(16):e009724. https://doi.org/10.1161/jaha.118.009724 . This is a seminal paper that highlighted the mortality associated with CLTI.
    1. Mustapha JA, Katzen BT, Neville RF, Lookstein RA, Zeller TH, Miller LE, et al. Critical limb ischemia: a threat to life and limb. Endovasc Today. 2019;18:80–2.
    1. •• Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69:3S–125S.e40. https://doi.org/10.1016/j.jvs.2019.02.016 . This paper discusses the new definition of CLTI.
    1. Duff S, Mafilios MS, Bhounsule P, Hasegawa JT. The burden of critical limb ischemia: a review of recent literature. Vasc Health Risk Manag. 2019;187–208. https://doi.org/10.2147/vhrm.s209241 .
    1. Agarwal S, Sud K, Shishehbor MH. Nationwide trends of hospital admission and outcomes among critical limb ischemia patients. J Am Coll Cardiol. 2016;67(16):1901–13. https://doi.org/10.1016/j.jacc.2016.02.040 . - DOI - PubMed

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