Abstract
Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease, defined as the presence of chronic ischemic rest pain, ulcers, or gangrene attributable to objectively proven arterial occlusive disease. The dominant pathology underlying CLI is atherosclerosis, distributed at multiple levels along the length of the lower extremity and with a propensity for involvement of the tibial vessels in the leg and the small vessels of the foot. To achieve limb salvage in patients with CLI, revascularization of the affected limb is generally required. In contemporary practice, endovascular techniques are rapidly replacing surgical bypass as the first option for revascularization for CLI based on high technical success rates and low rates of procedure-related morbidity and mortality. Endovascular therapy (EVT) is an emerging new technique for revascularization of lower limb ischemia. EVT is applied in iliac artery primarily but can be used in femoropopliteal artery. Above all, below the knee lesions in patients with CLI is best suited for EVT. We describe the clinical strategy of EVT first approach to revascularization in treating patients with CLI.
