ABSTRACT
Critical limb ischemia (CLI) is a highly morbid disease with many patients considered poor surgical candidates. The lack of treatment options for CLI has driven interest in developing molecular therapies within recent years. Through these translational medicine studies in CLI, much has been learned about the pathophysiology of the disease. Here, we present an overview of the macrovascular and microvascular changes that lead to the development of CLI, including impairment of angiogenesis, vasculogenesis, and arteriogenesis. We summarize the randomized clinical controlled trials that have used molecular therapies in CLI, and discuss the novel imaging modalities being developed to assess the efficacy of these therapies.
Subject(s)
Angiogenesis Inducing Agents/therapeutic use , Cardiovascular Agents/therapeutic use , Genetic Therapy/methods , Ischemia/therapy , Peripheral Arterial Disease/therapy , Angiogenesis Inducing Agents/adverse effects , Cardiovascular Agents/adverse effects , Critical Illness , Genetic Therapy/adverse effects , Humans , Ischemia/diagnosis , Ischemia/physiopathology , Microcirculation/drug effects , Neovascularization, Physiologic/drug effects , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/genetics , Peripheral Arterial Disease/physiopathology , Regional Blood Flow , Treatment OutcomeABSTRACT
Critical limb ischemia (CLI) is a terminal stage of peripheral arterial disease that, in the absence of intervention, may lead to lower extremity amputation or death. Endovascular interventions have become a first-line approach to the management of CLI and have advanced considerably within the past decade. This review summarizes the types of percutaneous devices and the techniques that are available for the management of CLI and the data supporting their use. These include devices that establish and maintain vessel patency, including percutaneous transluminal angioplasty, drug-coated balloons, bare metal stents, drug-eluting stents, bioresorbable vascular scaffolds, and atherectomy; devices that provide protection from embolization; and, cell-based therapies. Additionally, ongoing trials with important implications for the field are discussed.
