Selecting revascularization procedures for patients with peripheral arterial disease- Importance of outcome prediction -

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  • アウトカムを見据えた下肢血行再建選択

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The diversity in the CLI population in terms of preoperative patient risk and foot condition is one of the significant factors that make treatment strategies very complex. Diversity is important for not only preoperative status but also for prognosis of limbs and survival. Therefore, the treatment goal for each individual should be set by predicting each individual’s outcome before selecting the revascularization procedure. The minimum goal of CLI treatment should be limb salvage, but higher goals, such as complete ulcer healing, recovering walking ability, or improving QOL, can be achieved by durable revascularization with high-quality multidisciplinary approaches. After revascularization, the preoperative treatment goal should be modified to reflect the residual infection, re-stenosis of the revascularized artery, and foot deformity after minor amputation. Based on the above, four important factors: foot condition（WIfI classification）, vascular condition, general condition, and functional status of limbs and brain, are key for the initial decision-making process to select bypass surgery, endovascular treatment, or primary amputation.

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