Cleveland Clinic, Cleveland, Ohio.
Ochsner Clinical School of the University of Queensland, New Orleans, Louisiana.
J Am Coll Cardiol. 2016 Nov 1;68(18):2002-2015. doi: 10.1016/j.jacc.2016.04.071. Epub 2016 Sep 28.
Critical limb ischemia (CLI), the most advanced form of peripheral artery disease, is associated with significant morbidity, mortality, and health care resource utilization. It is also associated with physical, as well as psychosocial, consequences such as amputation and depression. Importantly, after a major amputation, patients are at heightened risk of amputation on the contralateral leg. However, despite the technological advances to manage CLI with minimally invasive technologies, this condition often remains untreated, with significant disparities in revascularization and amputation rates according to race, socioeconomic status, and geographic region. Care remains disparate across medical specialties in this rapidly evolving field. Many challenges persist, including appropriate reimbursement for treating complex patients with difficult anatomy. This paper provides a comprehensive summary that includes diagnostic assessment and analysis, endovascular versus open surgical treatment, regenerative and adjunctive therapies, and other important aspects of CLI.
严重肢体缺血(CLI)是外周动脉疾病的最严重形式,与较高的发病率、死亡率和医疗资源利用相关。它还与身体和心理社会后果相关,如截肢和抑郁。重要的是,在大截肢后,患者对另一侧腿部截肢的风险增加。然而,尽管有微创技术来治疗 CLI 的技术进步,但这种情况仍然未得到治疗,根据种族、社会经济地位和地理位置,血管重建和截肢率存在显著差异。在这个快速发展的领域,医疗专业之间的护理仍然存在差异。许多挑战仍然存在,包括为治疗具有复杂解剖结构的复杂患者提供适当的报销。本文提供了一个全面的总结,包括诊断评估和分析、腔内与开放手术治疗、再生和辅助治疗以及 CLI 的其他重要方面。