Experience Of Endovascular Treatment Of Critical Limb Ischemia

Background Critical limb ischemia is defined as limb pain that occurs at rest, or necrosis of limb that is caused by severe compromise of blood flow to the affected extremity which caused by stenosis and occlusion of the lower limb artery.critical limb ischemia (CLI) occurs after chronic lack of blood supply, setting off a cascade of pathophysiologic events that ultimately lead to rest pain or trophic lesions of the legs which include ulcers or gangrene of ischemic lower extremity, or both. Thus, CLI is considered the "end stage" of peripheral arterial disease (PAD).CLI is characterized by a high mortality and morbidity. Clinical studies have found 88% limb salvage rate at 1 year and the mortality rate of up to 25% in the CLI, although there are many methods for the treatment of CLI. Endovascular treatment, which have characteristics of minimally invasive and can be repeated operation, can significantly reduce the incidence of perioperative mortality and complications in patients with old age, underlying diseases, poor tolerance for traditional surgery. With the development of endovascular treatment techniques and materials, the clinical application of endovascular treatment is increasing, and its prospects were bright.Objective To discussion and analysis the outcomes of endovascular treatment for critical limb ischemia and its clinical value, improve the success rate of treatment of critical lower limb ischemia.Methods Clinical data and follow-up data of 32 patients (35 limbs) with critical limb ischemia treated by endovascular treatment in department of vascular surgery of Lanzhou university second hospital from September 2011-September 2013 were analyzed and summarized. Analysis and assess the clinical symptoms before and after surgery, the changes of ABI and the effects of CTA. Observed immediate effects after surgery, clinical efficacy during hospitalization, complications, changes of ABI. The situation of recanalization and ischemic symptoms of lower limb of patients was observed in the follow-up of 6-24 months.Results The success rate of endovascular procedure was 100% for iliac arteries and femoral-popliteal arteries, and 81.2% for infrapopliteal artery. Temperature of lower limb skin increased, rest pain eased or disappeared and the ulcers were healed after the operations.1 patient received amputation during the perioperative period,the rate of amputation was 8.9%. Compared with the preoperative, there was a significant difference (P< 0.05) for the average of ABI patients was 0.70. Mortality of patients endovascular intervened is 7.1%, the amputation rate is 3.5%, recurrence rate of ulcer is 7.1% and restenosis rate is 21.4%.Conclusion Endovascular technique is safe and effective in the treatment of critical limb ischemia. CLI still need further study cause it has a high morbidity.