Critical limb ischemia: Definition and natural history

Current Drug Targets - Cardiovascular and Haematological Disorders

Volumn 4, Issue 3, 2004, Pages 219-225

  Novo, S ^a   Coppola, G ^a   Milio, G ^a  

^a UNIVERSITY OF PALERMO   (Italy)

Author keywords

Amputation; Arterial occlusive disease; Cardiovascular morbidity; Cardiovascular mortality; Critical limb ischemia; Fontaine's classification; Peripheral arterial disease; Risk factors; Surgical revascularization

Indexed keywords

ACETYLSALICYLIC ACID; ANALGESIC AGENT; ANTITHROMBOCYTIC AGENT; CLOPIDOGREL; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; ILOPROST; PROSTAGLANDIN E1; PROSTANOID; RAMIPRIL; SIMVASTATIN; TICLOPIDINE; TOPICAL AGENT; VASCULOTROPIN; VASOACTIVE AGENT;

ACUTE DISEASE; AGING; BLOOD VESSEL GRAFT; CARDIOVASCULAR RISK; CHEMICAL SYMPATHECTOMY; CHRONIC DISEASE; CHRONICITY; CLINICAL FEATURE; CLINICAL TRIAL; COMPRESSION THERAPY; DEATH; DIABETES MELLITUS; DIFFERENTIAL DIAGNOSIS; GANGRENE; HEART INFARCTION; HUMAN; HYPERBARIC OXYGEN; IMMOBILIZATION; INCIDENCE; INTERMITTENT CLAUDICATION; LEG AMPUTATION; LEG ISCHEMIA; LEG PAIN; LEG REVASCULARIZATION; LEG ULCER; LIMB ISCHEMIA; LIMB SALVAGE; MEDICAL SPECIALIST; NEUROLOGIC DISEASE; PERIPHERAL OCCLUSIVE ARTERY DISEASE; PROGNOSIS; PUBLIC HEALTH; QUALITY OF LIFE; REST; REVIEW; RISK ASSESSMENT; SMOKING; STROKE; SURVIVAL; TREATMENT INDICATION;

AMPUTATION; ARTERIOSCLEROSIS; FOOT; GANGRENE; HUMANS; ISCHEMIA; LEG; PERIPHERAL VASCULAR DISEASES; RISK FACTORS;

EID: 4444338627     PISSN: 15680061     EISSN: None     Source Type: Journal    
DOI: 10.2174/1568006043335989     Document Type: Review

References (64)

1. Novo, S. The patients with intermittent claudication. Everyday problems in clinical cardiology. Excerpta Medica: Amsterdam, 1995, Vol. 5: no7.
2. Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). J. Vasc. Surg., 2000, 31, S1-S296.
3. Novo, S. Classification, epidemiology, risk factors and natural history of peripheral artery disease. Diabetes, Obesity and Metabolism, 2002, 4 (Suppl. 2), S1-S6.
4. Pasqualini, L.; Schillaci, G.; Vaudo, G.; Innocente, S.; Ciuffetti, G.; Mannarino, E. Predictors of overall and cardiovascular mortality in peripheral arterial disease. Am. J. Cardiol., 2001, 88, 1057-1060.
5. Kroger, K.; Stewen, C.; Santosa, F.; Rudofsky, G. Toe pressure measurements compared to ankle artery pressure measurements. Angiology, 2003, 4 (Suppl. 1), S39-S44.
6. Zwicky, S.; Mahler, F.; Baumgartner, I. Evaluation of clinical tests to assess perfusion in chronic critical limb ischemia. VASA, 2002, 31, 173-178.
7. Brillet, P.Y.; Tassart, M.; Bazot, M.; Le Blanche, A.P.; Allaire, E.; Boudghene, F. Investigation of peripheral vascular bed in critical lower limb ischemia: comparative study between arteriography and magnetic resonance angiography. J. Mal. Vasc., 2001, 26, 31-38.
8. Koelemay, M.J.; Lijmar, J.G.; Stoker, J.; Legemate, D.A.; Bossuyt, P.M. Magnetic resonance angiography for the evaluation of lower extremity arterial disease: a meta-analysis. JAMA, 2001, 285, 1338-1345.
9. Brillu, C.; Picquet, J.; Villapadierna, F.; Papon, K.; L'Hoste, P.; Jousset, Y.; Enon, B. Percutaneous transluminal angioplasty for management of critical ischemia in arteries below the knee, Ann. Vasc. Surg., 2001, 15, 75-81.
10. Jamsen, T.S,; Manninen, H.I.; Jaakkola, P.A.; Matsi, P.J. Long-term outcome of patients with claudication after balloon angioplasty of the femoro-popliteal arteries. Radiology, 2002, 225, 345-352.
11. Gray, B.H.; Laird, J.R.; Ansel, G.M.; Shuck, J.W. Complex endovascular treatment for critical limb ischemia in poor surgical candidates: a pilot study. J. Endovasc. Ther., 2002, 9, 599-604.
12. Prager, M.; Hoizenbein, T.; Aslim, E.; Domenig, C.h, Mulhbacher, F.; Kretschmer, G. Fresh arterial homograf transplantation: a novel concept for critical limb ischemia. Eur. J. Vasc. Endovasc. Surg., 2002, 24, 314-321.
13. Novo, S. Management of the diseases of the arteries of the lower limbs. In Angiology in the Practice. Salmasi, A.M. and Strano, A, Eds, Kluwer Academic Press: Dordrecht, The Netherlands, 1996, pp. 307-321.
14. Norgren, L. Pharmacotherapy for critical limb ischemia. Diabetes Metab. Res. Rev., 2000, 16 (Suppl. 1), S37-S41.
15. The ICAI Study Group. Prostanoids in chronic critical leg ischemia: The results of a large randomized Trial with Prostaglandin E1. Ann. Intern. Med., 1999, 130, 412-21.
16. Dawson, D.L.; Hagino, R.T. Critical Limb Ischemia. Curr. Treat. Options Cardiovasc. Med.; 2001, 3, 237-249.
17. Shyu, K.G.; Chang, H.; Wang, B.W.; Kuan, P. Intramuscular vascular endothelial growth factor gene therapy in patients with chronic critical leg ischemia. Am. J. Med, 2003, 114, 85-92.
18. Konstantinov, B.A.; Nechaenko, M.A.; Malinovskais, T.N.; Kulagina, T.I.; Minaev, V.V.; Tataian, M.V. Electrical stimulation of the spinal cord in cardiovascular disease. Vestn. Ross. Akad. Med. Nauk., 2002, 5, 17-23.
19. Spincemaille, G.H.; de Vet, H.C.; Ubbink, D.T.; Jacobs, M.J. The results of spinal cord stimulation in critical limb ischemia: a review. Eur. J. Vasc. Endovasc. Surg., 2001, 21, 99-105.
20. Tomlinson, L. Case study to illustrate a multidisciplinary approach to a case of critical limb ischemia and the role of chemical lumbar sympathectomy. J. Tissue Viabilità, 2000, 10, 140-143.
21. Delis, K.; Husmann, M.; Nicolaides, A.; Wolfe, J.; Cheshire, N. Enhancing foot skin blood flow flux in peripheral vascular disease using intermittent pneumatic compression: controlled study on claudicants and grafted arteriopathies. World J. Surg., 2002, 26, 861-866.
22. Kroese, A.J.; Strande, E. How critical is chronic critical leg ischaemia? Ann. Chir, Gynaecol., 1998, 87, 141-144.
23. Fontaine, R.; Kim, M.; Kieny, R. Die chirurgische Behandlung der peripheren Durch-blutungsstorungen. Helvetia Chirurgica Acta, 1954, 5/6, 199-533.
24. Second European Consensus Document on Chronic Critical Leg Ischemia. Circulation, 1991, 84 (Suppl.4), 1-26.
25. The Vascular Surgical Society of Great Bretain and Ireland. Critical limb ischemia: management and outcome. Report of a National Survey. Eur. J. Vasc. Endovasc. Surg., 1995, 10, 108-113.
26. Matzke, S.; Lepantalo, M. Claudication does not always precede critical leg ischemia. Vasc. Med., 2001, 6, 77-80.
27. Eickhoff, J.H.; Hansen, H.J.; Lorentzen, J.E. The effect of arterial reconstruction on lower limb amputation rate. An epidemiological survey based on reports from Danish hospitals. Acta. Chir. Scand. Suppl., 1980, 502, 181-187.
28. Da Silva, A.; Widmer, L.K.; Ziegler, H.W.; Nissen, C.; Schweiger, W. The Basle longitudinal study; report on the relation of initial glucose level to baseline ECG abnormalities, peripheral artery disease, and subsequent mortality. J. Chorn. Dis., 1979, 32, 797-803.
29. McGrath, M.A.; Graham, A.R.; Hill, D.A.; Lord, R.S.; Tracy, G.D. The natural history of chronic leg ischemia. World J. Surg., 1983, 7, 314-318.
30. Taylor, L.M.; Hamre, D.; Dalman, R.L.; Porter, J.M. Limb salvage vs amputation for critical ischemia: the role of vascular surgery. Arch. Surg., 1991, 126, 1251-1258.
31. Hickey, N.C.; Thomson, I.A.; Shearman, C.P.; Simms, M.H. Aggressive arterial reconstruction for critical lower limb ischaemia. Br. J. Surg., 1991, 78, 1476-1478.
32. Norgren, L.; Alwmark, A.; Angqvist, K.A.; Hedberg, B.; Bergqvist, D.; Takolander, R.; Claes, G.; Lundell, A.; Holm, J.; Jivegard, L.; et al. A stable prostacyclin analogue (iloprost) in the treatment of ischaemic ulcers of the lower limb. A Scandinavian- Polish placebo controlled, randomised multicenter studies. Eur. J. Vasc. Surg., 1990, 4, 463-637.
33. Bliss, B.; Wilkins, D.; Campbell, W.B. Treatment of limb threatening ischaemia with intravenous Iloprost: a randomised double-blind placebo-controlled study. Eur. J. Vasc. Surg., 1997, 5, 511-516.
34. Kugler, C.F.; Rudofsky, G. The challenges of treating peripheral arterial disease. Vasc. Med, 2003, 8, 109-14.
35. Shigematsu, H. Endovascular procedures for peripheral arterial disease. Nippon Geka Gakkai Zasshi, 2003, 8, 562-6.
36. Tunis, S.R.; Bass, E.B.; Steinberg, E.P. The use of angioplasty, by-pass surgery, and amputation in the management of peripheral vascular disease. New Engl. J. Med., 1991, 325, 556-62.
37. Karlstrom, L.; Bergqvist, D. Effects of vascular surgery on amputation rates and mortality. Eur. J. Vasc. Endovasc. Surg., 1997, 14, 273-283.
38. Molloy, K.J.; Nasim, A.; London, N.J.; Naylor, A.R.; Bell, P.R.; Fishwick, G.; Bolia, A.; Thompson, M.M. Percutaneous translumnal angioplasty in the treatment of critical limb ischemia. J. Endovasc. Ther., 2003, 2, 298-303.
39. Nasr, M.K.; McCarthy, R.J.; Hardman, J.; Chalmers, A,; Horrocks, M. The increasing role of percutaneus transluminal angioplasty in the primary management of critical limb ischaemia. Eur. J. Endovasc. Surg., 2002, 5, 398-403.
40. Ebskov, L.B.; Schroeder, T.V.; Holstein, P.E. Epidemiology of leg amputation: the influence of vascular surgery. Br. J. Surg., 1994, 81, 1600-1603.
41. Luther, M. The influence of arterial reconstructive surgery on the outcome of critical leg ischaemia. Eur. J. Vasc. Surg., 1994, 8, 682-689.
42. Pell, J.P.; Fowkes, F.G.; Ruckley, C.V.; Clarke, J.; Kendrick, S.; Boyd, J.H. Declining incidence of amputation for arterial disease in Scotland. Eur. J. Vasc. Surg., 1994, 8, 602-606.
43. Matzke, S.; Biancari, F.; Ihlberg, L.; Alback, A.; Kantonen, I.; Rallo, M.; Lepantalo, M. Increased preoperative C-reactive protein level as a prognostic factor for postoperative amputation after femoro-popliteal bypass surgery for CLI. Ann. Chir. Gynaecol., 2001, 90, 19-22.
44. Wolfe, J.N. Defining the outcome of critical ischaemia: a one year prospective study. Br. J. Surg., 1986, 73, 321.
45. Tripses, D.; Pollak, E.W. Risk factors in healing of below-knee amputation. Appraisal of 64 amputations in patients with vascular disease. Am. J. Surg., 1981, 141(6), 718-720.
46. Burgess, E.M.; Matsen, F.A. 3rd, Wyss, C.R.; Simmons, C.W. Segmental transcutaneous measurements of PO2 in patients requiring below-the-knee amputation for peripheral vascular insufficiency. J. Bone Joint Surg. Am., 1982, 64(3), 378-382.
47. Dormandy, J.; Belcher, G.; Broos, P.; Eikelboom, B.; Laszlo, G.; Konrad, P.; Moggi, L.; Mueller, U. Prospective study of 713 below-knee amputations for ischaemia and the effect of a prostacyclin analogue on healing. Hawaii Study Group. Br. J. Surg., 1994, 81(1), 33-37.
48. Kihn, R.B.; Warren, R.; Beebe, G.W. The geriatric amputee. Ann. Surg., 1972, 176, 305-314.
49. Loosemore, T.M.; Chalmers, T.C.; Dormandy, J.A. A meta-analysis of randomised placebo-controlled trials in Fontaine stages III and IV peripheral occlusive arterial disease. Int. Angiol., 1994, 13, 33-42.
50. Banyay, S.; Jenelten, R.; Wagner, S.; Alimann, J.; Banyai, M.; Koppensteiner, R. Outpatient treatment of severe peripheral ischemia with intravenous intermittent low-dose Iloprost. An open pilot study. Int. Angiol., 2002, 21, 36-43.
51. Belcaro, G.; Nicolaides, A.N.; Cipollone, G.; Laurora, G.; Incandela, L.; Cazaubon, M.; Barsotti, A.; Ledda, A.; Errichi, B.M.; Cornelli, U.; Dugall, M.; Corsi, M.; Mezzanotte, L.; Geroulakos, G.; Fisher, C.; Szendro, G.; Simeone, E.; Cesarone, M.R.; Nucci, M.; Agus, G.; De Sanctis.; M.T, Ricci, A.; Ippolito, E.; Vasdekis, S.; Cristopoulos, D.; Helmis, H. Normograms used to define the short-term treatment with PGE1 in patients with intermittent claudication and critical ischemia. The ORACLE (Occlusion Revascularization in the Atherosclerotic Critical Limb) Study Group. The European Study. Angiology, 2000, 51 (suppl. 8 part 2), S3-S13.
52. Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet theraphy. I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet theraphy in various categories of patients. BMJ, 1994, 308, 81-106.
53. Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet theraphy. II: maintenance of vascular graft or arterial patency by antiplatelet theraphy therapy. BMJ, 1994, 308, 159-168.
54. CAPRIE Steering Committee. A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet, 1996, 348, 1329-39.
55. Palmer-Kazen, U.; Wahlberg, E. Arteriogenesis in peripheral arterial disease. Endothelium, 2003, 10, 225-32.
56. Novo, S, Coppola, G. The Cardiovascular Risk Burden of Peripheral Arterial Disease (PAD). Invited Reports from the 17th International Congress on Thrombosis, Monduzzi Editore: Bologna - MEDIMOND Inc.; 2002, CX26R9044, 231-8
57. Vogt, M.T.; Cauley, J.A.; Newman, A.B.; Kuller, L.H.; Hulley, S.B. Decreased ankle/arm blood pressure index and mortality in elderly women. JAMA, 1993, 270(4), 465-469.
58. The I.C.A.I. Group (Gruppo di Studio dell'ischemia critica degli arti inferiori). Long-term mortality and its predictors in patients with critical limbs ischemia. Eur. J. Vasc. Surg., 1997, 14, 91-95.
59. Schneider, E.; Gruntzig, A.; Bollinger, A. Die perkutane transluminale Angioplastie (PTA) in den Stadien III und IV der peripheren arteriellen Verschlusskrankheit. VASA, 1982, 11, 336-339.
60. Walker, S.R.; Yusuf, S.W.; Wenham, P.W.; Hopkinson, B.R. Renal complications following endovascular repair of abdominal aortic aneurysms. J. Endovasc. Surg., 1998, 5, 318-322.
61. Pedrinelli, R.; Dell'Omo, G.; Barchielli, A.; Berchiolli, R.; Melillo, E.; Mariani, M.; Balbarini, A.; Ferrari, M. Fibrinogen and mortality in chronic critical limb ischemia. J. Intern. Med., 1999, 245, 75-81.
62. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Br. Med. J., 2002, 324, 71-86.
63. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20, 536 high-risk individuals: a randomised placebo-controlled trial. Lancet, 2002, 360, 7-22.
64. The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N. Engl. J. Med., 2000, 342, 145-153.