Revascularization Techniques to Prevent Limb Amputation Presenting Distal Necrosis

In 2010, the prevalence of peripheral arterial disease was 202 million patients globally, an increase of 23.5% compared to 2000 [1]. In its most severe forms, peripheral arterial disease presents as chronic limb-threatening ischemia (CLTI). It is an advanced stage of disease with ischemic rest pain and/or presenting ischemic ulcer or gangrene for at least 2 weeks and severe alteration of lower limb perfusion characterized by ankle-brachial index inferior to 0.4, ankle pressure inferior to 50 mmHg, toe pressure inferior to 30 mmHg, and transcutaneous partial pressure of oxygen (tcPO2) inferior to 30 mmHg [2]. It is associated with a high risk of amputation and death. The prevalence increases dramatically with age, from 6.5% in men aged 60–69 years to 29.4% in men over 80 years [3]. Without revascularization, 31.6% died and 23% required major amputation within 2 years [4]. In a Danish registry, a reduction of major amputation rate was observed from 41.67 for 100,000 subjects per year to 32.53 between two periods: 1997–2002 and 2009–2014. This was coupled with an increase in vascular surgeon referrals from 25.7% to 31.3% from 1997 to 2014 [5].