Abstract
This study aims at the assessment of the achievability of the endovascular treatment
of patients with critical limb ischemia (CLI) and the role of bypass in such patient.
This is a prospective study conducted on patients with chronic atherosclerotic critical
lower limb ischemia presenting to us over a period of 3 years. Patients presenting
with nonsalvageable limbs requiring primary major amputation and nonatherosclerotic
causes of CLI were excluded. Endovascular treatment was the first choice modality
of treatment in revascularization of all patients. Open surgery was offered selectively
for patient whom endovascular failed or complicated and for long TransAtlantic Inter-Society
Consensus (TASC) II lesions in fit patients. This study included 511 cases of CLI,
and the mean age was 64.5 years. Patients with Rutherford IV, V, and VI were 19.25,
60.5, and 19.25%, respectively. The TASC II aortoiliac lesions were as follows: A,
B, C, and D in 33.7, 12,15.7, and 38.6%, respectively, and infrainguinal lesions were
A, B, C, and D in 3.7, 19, 35.4, and 68.3%, respectively. A total of 78.3% of patients
were treated by endovascular totally, while 16% were treated by surgery from the start,
3.7% of endovascular cases were converted to open surgery after failure of endovascular
treatment, and 2% was offered hybrid treatment. Crossing of lesions by subintimal
and intraluminal was 12.5 and 87.5%, respectively. Technical success in endovascular
was 94%; however, we could successfully revascularize 96.8% of all CLI presented in
this study by either surgery or endovascular. On 24 months follow-up, primary patency,
secondary patency, and limb salvage by percutaneous transluminal angioplasty are 77.8,
84.7, and 90.7%, respectively. Revascularization by endovascular achieves high technical
success and limb salvage in CLI, hence should be considered as preferred choice of
treatment. However, both endovascular and surgery should not be counteracting each
other and using both can revascularize 96.6% of CLI.
Keywords
critical limb ischemia - peripheral occlusive disease - peripheral angioplasty - limb
salvage - survival
