Chronic Limb Threatening Ischemia: Current Trendsin Surgical Revascularization

Uchida Hisashi, Takahashi Kazuki, Tada Yuki, Okuda Hiroko, Yoshida Hiroki

doi:10.34466/jjsfcpm.2.2_59

The concept of CLTI (chronic limb threatening ischemia) was presented in 2017, and in 2019, Worldwide Society of Vascular Surgery jointly created the global vascular guideline (GVG) in which treatment guidelines for CLTI were presented. Behind this series of flows, conventional treatment guidelines may not match the actual situation of on-the-ground clinical practice due to the diversification of the pathophysiology of lower limb lesions due to the rapid increase in diabetes mellitus and advances in endovascular treatment (EVT) . Currently, about 75% of CLTI’s first-line arterial reconstruction are EVT around the world, and the indication of EVT for below knee popliteal (BKP) artery continues to expand. There is a difference in thinking between some endovascular physicians and vascular surgeons about the positioning of EVT for BKP arteries and distal bypass in CLTI treatment. This paper introduces the GVG latest treatment guidelines for CLTI, and shows clinical results of the distal bypass in our hospital, followed by two or more EVT for BKP arteries have adversely affects later distal bypass results (2-year AFS, 2-year graft patency) . It is desirable to correctly understand the surgical treatment results including distal bypass and carefully establish their EVT indications.

Chronic Limb Threatening Ischemia: Current Trendsin Surgical Revascularization

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