Berchiolli R, Bertagna G, Adami D, Canovaro F, Torri L, Troisi N, et al.
Journal of clinical medicine. Date of publication 2023 Apr 4;volume 12(7):.
1. J Clin Med. 2023 Apr 4;12(7):2682. doi: 10.3390/jcm12072682.
Chronic Limb-Threatening Ischemia and the Need for Revascularization.
Berchiolli R(1), Bertagna G(1), Adami D(1), Canovaro F(1), Torri L(1), Troisi
N(1).
Author information:
(1)Vascular Surgery Unit, Department of Translational Research and New
Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy.
BACKGROUND: Patients presenting with critical limb-threatening ischemia (CLTI)
have been increasing in number over the years. They represent a high-risk
population, especially in terms of major amputation and mortality. Despite
multiple guidelines concerning their management, it continues to be challenging.
Decision-making between surgical and endovascular procedures should be well
established, but there is still a lack of consensus concerning the best
treatment strategy. The aim of this manuscript is to offer an overview of the
contemporary management of CLTI patients, with a focus on the concept that
evidence-based revascularization (EBR) could help surgeons to provide more
appropriate treatment, avoiding improper procedures, as well as too-high-risk
ones.
METHODS: We performed a search on MEDLINE, Embase, and Scopus from 1 January
1995 to 31 December 2022 and reviewed Global and ESVS Guidelines. A total of 150
articles were screened, but only those of high quality were considered and
included in a narrative synthesis.
RESULTS: Global Vascular Guidelines have improved and standardized the way to
classify and manage CLTI patients with evidence-based revascularization (EBR).
Nevertheless, considering that not all patients are suitable for
revascularization, a key strategy could be to stratify unfit patients by
considering both clinical and non-clinical risk factors, in accordance with the
concept of individual residual risk for every patient. The recent BEST-CLI trial
established the superiority of autologous vein bypass graft over endovascular
therapy for the revascularization of CLTI patients. However, no-option CLTI
patients still represent a critical issue.
CONCLUSIONS: The surgeon's experience and skillfulness are the cornerstones of
treatment and of a multidisciplinary approach. The recent BEST-CLI trial
established that open surgical peripheral vascular surgery could guarantee
better outcomes than the less invasive endovascular approach.
DOI: 10.3390/jcm12072682
PMCID: PMC10095037
PMID: 37048765
Conflict of interest statement: The authors declare no conflict of interest.
