March 2024

Presence of calcification is a significant risk factor for treatment resistance during endovascular therapy, limiting vessel expansion and increasing rates of complication. The goal of this study is to assess the safety and efficacy of intravascular lithotripsy in the treatment of calcified peripheral arterial lesions in patients with claudication. 

The pattern of surgical bypass has affected practice in the context of a multidisciplinary limb preservation program. As bypass may be required for limb preservation, such a practice would involve more frequent bypass and increased complexity of bypass performed due to the lack of an autogenous conduit and suitable target artery (“desert foot”), and patients with prior failed endovascular interventions. We investigated this change in the pattern of bypass performed in the context of our limb preservation program. 

Abdelghany et al, acting on behalf of the Publication Committee of the Critical Limb Ischemia Global Society, presented an insightful analysis detailing the historical progression of chronic limb-threatening ischemia (CLTI) treatment. This historical journey has been marked by numerous pioneering discoveries and breakthroughs. 

While strides have been made in the attention that CLTI is afforded, there continue to be challenges regarding a lack of equipoise in the management of CLTI. Addressing the significant disparities in CLTI care, especially in underserved communities, necessitates a multifaceted approach. 

Upper extremity CLTI attributable to infrabrachial chronic arterial occlusive disease is an infrequently encountered problem in clinical practice for which no evidence-based treatment algorithm exists. Here the authors describe their approach to a patient with right upper extremity CLTI and limited arterial runoff into the hand.

The definition and treatment of CLTI have been evolving, recognizing the importance of early recognition and aggressive treatment required for those patients. In this article, the authors discuss the historical definitions of CLTI and provide an overview of how the management of patients with CLTI has developed, including surgical and endovascular interventions.

In this study and review, the authors aim to provide a focused evaluation of the influence of SES on the care, prevalence, and treatment of peripheral arterial disease and critical limb-threatening ischemia.