Management and outcomes of critical limb ischemia

Peripheral artery disease (PAD) is the chronic manifestation of progressive atherosclerotic disease burden in the lower extremities. Risk factors for the development of PAD do not differ from other atherosclerotic diseases and thus include age, male sex, smoking, diabetes, hypertension, dyslipidemia, and genetic predisposition. Although PAD has inherent and significant associated cardiovascular and cerebrovascular event risks, critical limb ischemia (CLI), or the presentation of PAD with tissue loss or ischemic pain in the foot at rest, carries an additional increased risk of mortality and limb loss. Recent studies report both a 1-year mortality and major amputation rate of approximately 22% in patients with CLI in a cohort that included patients who had undergone vascular and limbpreserving interventions. Within this chapter we discuss both the operative and non-operative approaches to the treatment and management of CLI as well as their associated risks and outcomes.