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Online ISSN 1827-1847
Donas K. P., Torsello G.
Department of Vascular Surgery, St. Franziskus Hospital Münster and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
The burden of critical limb ischemia (CLI) is progressively rising, because of an increasing prevalence of diabetes mellitus and greater life expectancy in developed countries. There is no doubt, that distal bypass grafting is a standardized and well-accepted treatment option with good long-term results. However, patients with CLI have severe comorbidities which can influence the outcome of arterial revascularization. Additionally, the introduction of dedicated minimal invasive techniques has made percutaneous arterial revascularization an attractive alternative and therefore is being used increasingly for the treatment of patients with CLI and tibioperoneal lesions. The primary goal of any endoluminal approach is aimed to restore straight in-line blood flow to the foot in at least one vessel in order to limb salvage. It offers the advantages of local anaesthesia, shorter hospital stay and the option of re-intervention in case of a new clinical impairment. However, only patients in Rutherford classes 4-6 should be candidates for infragenicular revascularization. The clinical success of an infrapopliteal intervention depends on patient optimization with medical control of life-threatening co-morbidities and good inflow into the infragenicular region which must be secured by either endovascular or surgical approach.