Invasive Cardiology Unit, Istituto Clinico Città di Brescia, Brescia, Italy.
Catheter Cardiovasc Interv. 2010 Feb 15;75(3):433-43. doi: 10.1002/ccd.22287.
Chronic critical limb ischemia (CLI) still represents the most common cause for amputation and frequently the possibility for peripheral revascularization, particularly in below knee (BK) arteries, is not adequately evaluated before amputation. This may also be due to the fact that even today, there's some confusion about results of the endovascular treatment in this territory. Diabetics, representing the population most frequently affected by CLI, have specific clinical characteristics, the so called diabetic foot syndrome, which cannot be compared with the situation in nondiabetic patients with ischemic ulcers. Measuring the success of BK endovascular therapy can be a difficult issue, considering that it is often the work of a multidisciplinary team. The clinical benefit of BK endovascular therapy often shows a large discrepancy from the primary patency. While ulcer healing, limb salvage, and reintervention rates are usually low after BK endovascular therapy, rates of restenosis remain excessively high. Nevertheless, the positive impact of revascularization on mortality, which mainly depends on the major amputation rate reduction, is also evident. This review article summarizes indications and clinical outcomes after BK endovascular therapy with special attention to the role of diabetes mellitus in patients with CLI.
慢性严重肢体缺血（CLI）仍然是最常见的截肢原因，而且在截肢前，通常不能充分评估下肢（BK）动脉的外周血运重建的可能性。这可能也是因为即使在今天，对于该领域血管内治疗的结果仍存在一些混淆。糖尿病患者是 CLI 最常发生的人群，他们具有特定的临床特征，即所谓的糖尿病足综合征，与非糖尿病缺血性溃疡患者的情况无法相比。考虑到 BK 血管内治疗通常是多学科团队的工作，因此衡量 BK 血管内治疗的成功可能是一个困难的问题。BK 血管内治疗的临床获益通常与初始通畅率存在较大差异。虽然 BK 血管内治疗后溃疡愈合、肢体挽救和再介入率通常较低，但再狭窄率仍然过高。尽管如此，血运重建对死亡率的积极影响（主要取决于大截肢率的降低）也是显而易见的。本文综述了 BK 血管内治疗的适应证和临床结果，特别关注糖尿病患者 CLI 中的作用。
