REVIEW  SAVE THE SEVERELY ISCHEMIC LIMB: THE JOINT PRACTICAL APPROACHES Free access

Italian Journal of Vascular and Endovascular Surgery 2020 December;27(4):182-9

DOI: 10.23736/S1824-4777.21.01482-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Attempting mini-invasiveness in the critically ill patient - the endovascular first act: restoring the flow in the iliacs and in the aorta

Yves ALIMI ^{1, 2} ✉

¹ Department of Vascular Surgery, Hôpital Nord, Marseille, France; ² Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix-Marseille University, Marseille, France

With an estimated yearly incidence of 500 to 1000 new cases per million individuals in Western society, critical limb ischemia (CLI) poses a substantial burden on patients, healthcare providers, and resources. In this review article, we noted that CLI represent 22 to 45% of larges series of aortoiliac stenting, even if regularly completed with infraunguinal restorations. CLI is generally associated with the more complexe aortoiliac lesions (TASC C and D lesions), with generally supra and infra-inguinal multilevel occlusive arterial disease, in an elderly and high-risk population. The different endovascular techniques for the treatment of severe aorto-iliac lesions are associate with an early success rate ranging from 86 to 95% depending of TASC classification. Perioperative death and complications are respectively of 0.3% and 6.3%. Midterm patency is obtained in 66 to 75% in case of rest pain, and 75% in case of tissue loss, with a limb salvage rate of respectively of 100% and 73%. These encouraging results lead to choose endovascular technique as a first choice over open surgery, especially in case of major comorbidities in high-risk patients.

KEY WORDS: Ischemia; Endovascular procedures; Review