In Patients with Limb-Threatening Ischemia Who Are Not Candidates for Revascularization Do Non-operative Options Improve Outcomes Compared to Amputation?

Abstract

Patients with critical limb ischemia (CLI) or limb-threatening ischemia comprise a heterogenous population with varying co-morbidities that strongly influence outcomes after therapeutic intervention. Broadly, there are three treatment strategies for patients with limb-threatening ischemia: direct revascularization (open or endovascular), amputation and medical treatment with local wound care. Although many affected patients do well with surgical revascularization, disease recurrence brings many patients back with ever-diminishing surgical options. This review discusses clinical decision-making, and particularly evaluates options for patient care when arterial anatomy or patient co-morbidities do not support surgical revascularization. This topic is an increasingly important one as data indicate direct intervention is not always a reasonable clinical option and as definitions for therapeutic success progress beyond graft/stent patency and limb salvage and non-surgical options to promote wound healing improve.