REVIEW  BELOW THE KNEE INTERVENTIONS FOR CLTI Free access

The Journal of Cardiovascular Surgery 2021 April;62(2):111-7

DOI: 10.23736/S0021-9509.21.11654-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Outcomes of open and hybrid treatments in below the knee pathology for critical limb threatening ischemia

Muzzafer A. CHAUDERY ✉, Sanjay D. PATEL, Hany ZAYED

Department of Vascular Surgery, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK

INTRODUCTION: The optimal management of below the knee pathology remains one of the most challenging areas for revascularization in patients presenting with critical limb threatening ischemia. Patients commonly have multilevel lesions and have a high amputation rate and associated mortality. This review aimed to assess the outcomes of below the knee revascularization strategies.
EVIDENCE ACQUISITION: An online literature search of medical databases for original articles or review articles was conducted using mesh terms.
EVIDENCE SYNTHESIS: Bypass surgery remains the gold standard for revascularization with good long-term outcomes with regards to patency, limb salvage, and quality of life but is associated with a higher morbidity than the endovascular approach. Given the increasing frailty of our patients, endovascular treatments have become the preferred strategy with results that are now equal to bypass. Hybrid surgery is an increasingly popular option as it combines the benefits of both endovascular and open surgery and although the evidence base is small the outcomes are encouraging.
CONCLUSIONS: Hybrid surgery offers promising results and could be considered in the treatment of multi-level lower limb arterial disease especially in high-risk patients or those who are not suitable for either open or endovascular techniques as a sole treatment modality.

KEY WORDS: Ischemia; Limb salvage; Vascular patency; Peripheral arterial disease; Risk factors; Wound healing