University of Colorado, Aurora, CO 80045, USA.
Prog Cardiovasc Dis. 2011 Jul-Aug;54(1):47-60. doi: 10.1016/j.pcad.2011.02.009.
Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease, defined as the presence of chronic ischemic rest pain, ulcers, or gangrene attributable to objectively proven arterial occlusive disease. The dominant pathology underlying CLI is atherosclerosis, distributed at multiple levels along the length of the lower extremity and with a propensity for involvement of the tibial vessels in the leg and the small vessels of the foot. To achieve limb salvage in patients with CLI, revascularization of the affected limb is generally required. In contemporary practice, endovascular techniques are rapidly replacing surgical bypass as the first option for revascularization for CLI based on high technical success rates and low rates of procedure-related morbidity and mortality. This review will describe the clinical strategy of the authors who have adopted an endovascular-first approach to revascularization in treating patients with CLI and summarize the clinical outcomes of endovascular therapy in this population.
严重肢体缺血（CLI）代表外周动脉疾病的最严重临床表现，其定义为存在慢性缺血性静息痛、溃疡或坏疽，归因于可客观证实的动脉闭塞性疾病。CLI 主要的病理学基础是动脉粥样硬化，沿下肢长度分布在多个层面，并有累及小腿血管和足部小血管的倾向。为了实现 CLI 患者的肢体保存，通常需要对受影响的肢体进行血运重建。在当代实践中，基于较高的技术成功率和较低的与手术相关的发病率和死亡率，腔内技术正在迅速取代旁路手术成为 CLI 血运重建的首选方法。这篇综述将描述作者采用腔内优先的方法进行血运重建治疗 CLI 患者的临床策略，并总结该人群中腔内治疗的临床结果。
