Below the knee interventions in critical limb ischemia

Peripheral arterial disease (PAD) of the lower extremities is one of the major manifestations of systemic atherosclerosis affecting 8-12 million people. Critical limb ischemia (CLI) represents the most severe clinical manifestation of lower extremity PAD and is defined as “greater than 2 weeks of rest pain, ulcers, or tissue loss attributed to arterial occlusive disease”. Infrainguinal distal bypass surgery has long been considered the gold standard treatment for CLI but a great number of patients are not eligible because of various underlying comorbidities commonly present in the CLI population or the absence of suitable vein conduits and/or patent non-diseased distal run-off vessels. At present, balloon angioplasty, also known as percutaneous transluminal angioplasty (PTA), is the primary technique to consider in endovascular treatment of below-the-knee (BTK) occlusive disease with success rates of infrapopliteal (IP) PTA reported to be as high as 80-100%.