HEMODYNAMIC AND ANATOMICAL REVASCULARIZATION STRATEGIES FOR CRITICAL LIMB ISCHEMIA

Rustamova Zebiniso Kuvondikovna

Authors

Rustamova Zebiniso Kuvondikovna Urgench Ranch University of Technology Department of Medical and Biological Sciences Student of the General Medicine (Treatment) program

Keywords:

critical limb ischemia, revascularization, endovascular therapy, bypass surgery, limb salvage, peripheral arterial disease, hemodynamic strategy, anatomical strategy, GLASS classification.

Abstract

Critical limb ischemia (CLI) represents the most severe manifestation of peripheral arterial disease (PAD), characterized by chronic ischemic rest pain, tissue loss, or gangrene. Revascularization is essential for limb salvage, and treatment strategies are broadly categorized into hemodynamic (endovascular) and anatomical (surgical) approaches. This study aimed to analyze and compare the efficacy, safety, and clinical outcomes of hemodynamic versus anatomical revascularization strategies in patients with critical limb ischemia. The research was conducted using a theoretical and analytical approach based on a comprehensive review of modern scientific literature in vascular surgery, interventional radiology, and cardiovascular medicine. Particular attention was given to large-scale randomized controlled trials, meta-analyses, and clinical guidelines published between 2015 and 2025.The results demonstrate that both endovascular and surgical revascularization strategies achieve comparable limb salvage rates at 1–2 years, with endovascular approaches offering lower perioperative morbidity and mortality but higher rates of reintervention. Anatomical bypass surgery provides superior long-term patency for certain lesion types, particularly in patients with adequate venous conduit and favorable anatomy. Treatment selection should be individualized based on patient risk factors, anatomical complexity, and available autologous conduit.

References

Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69(6S):3S-125S.

Farber A, Menard MT, Conte MS, et al. Surgery or endovascular therapy for chronic limb-threatening ischemia. N Engl J Med. 2022;386(23):2195-2206. (BEST-CLI trial)

Bradbury AW, Moakes CA, Popplewell M, et al. A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who require an infrapopliteal bypass. Lancet. 2023;401(10390):1798-1809. (BASIL-2 trial)

Menard MT, Farber A, Assmann SF, et al. Design and rationale of the BEST-CLI trial. J Vasc Surg. 2020;71(5):1557-1565.

Popplewell MA, Davies H, Jarrett H, et al. Bypass versus angioplasty in severe ischaemia of the leg – 2 (BASIL-2) trial. J Vasc Surg. 2022;75(3):1030-1040.

Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(1):S5-S67.

Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease. Circulation. 2017;135(12):e686-e725.

Mustapha JA, Finton SM, Diaz-Sandoval LJ, et al. Percutaneous transluminal angioplasty in patients with infrapopliteal arterial disease. J Am Coll Cardiol. 2021;77(6):745-756.

Iida O, Takahara M, Soga Y, et al. Three-year outcomes of drug-coated balloon angioplasty for femoropopliteal lesions. JACC Cardiovasc Interv. 2020;13(4):476-485.

Cheng TW, Farber A, Kalish JA, et al. Vein versus prosthetic graft for infrainguinal bypass. J Vasc Surg. 2021;74(2):525-534.