The Impact of Repeat Endovascular Treatment on Critical Limb-Threatening Ischemia for Limb Salvage

TL;DR

Repeated endovascular treatments can effectively prevent amputation in severe leg ischemia cases when other options are not viable.

Contribution

Demonstrates the practicality of repeated endovascular therapy for limb salvage in complex ischemia cases.

Findings

Repeated endovascular therapy was used successfully four times to treat chronic limb-threatening ischemia.

The treatment prevented major amputation and preserved foot function in an elderly patient with comorbidities.

Improved outcomes with modern devices make endovascular treatment a viable alternative to surgery.

Abstract

Chronic limb-threatening ischemia due to chronic total occlusion of below-the-knee lesions is one of the most challenging cases for endovascular treatment. Restoring perfusion is crucial, and its success depends on numerous factors. Owing to the recent development of dedicated devices and techniques, endovascular treatment is becoming an alternative to bypass surgery as a first-line treatment, even for the infra-popliteal lesion, because endovascular recanalization outcomes have considerably improved. In our present case, a self-expandable Nitinol stent was placed in the tibio-peroneal trunk to treat chronic limb-threatening ischemia. At its recurrence four years later, endovascular therapy was employed because the patient had concomitant diseases and advanced age. Finally, four times repeated revascularization prevented major amputation and preserved the functional foot. This report demonstrates that repeated endovascular therapy was practical and feasible to achieve limb salvage and preserve the functional foot.

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