Therapy for patients with critical limb Ischemia
The primary goals of treatment in patients with CLI are relieving ischemic pain, healing ulcers, preventing limb loss, improving patient function, quality of life and prolong overall survival. Prompt surgical or endovascular revascularization or a combination of techniques, is currently recommended as the optimal therapy for limb salvage in CLI [4-6]. The present article will focus on available evidence supporting medical interventions aimed at reducing high rates of cardiovascular events and death and improving CLI management and care. Adjunct pharma-cotherapy directed to optimize outcomes after revascularization procedures will also be re-viewed.
Risk Factor Modification and Medical Therapy …show more content…
Aggressive risk factor modification is the initial therapy of both intermittent claudication (IC) and CLI. Notable Class I recommendations include blood pressure control, use of aspirin or clopidogrel, and statins. It is also important to note that diabetes mellitus is an independent risk factor for am-putations in patients with CLI [7-8]. Therefore, hemoglobin AIC and regulation of blood glu-cose levels in diabetics are also of utmost importance [5, 9]. However, in contrast to IC, treatment of CLI warrants a more aggressive approach. The natural history of CLI and its grim prognosis mandates a more aggressive strategy and treatment of underlying ischemia. In addition, the evidence of the effectiveness of therapies such as aspirin to prevent cardiovascu-lar events is not sufficiently established and proven in CLI patients, except in PREVENT III trial (Project of Ex-Vivo vein graft Engineering via Transfection III) where in retrospective analysis of 1,404 CLI patients reported that use of statins did not alter operative outcomes but was associated with reduced 1-year mortality rate after surgical revascularization.
The primary goals of treatment in patients with CLI are relieving ischemic pain, healing ulcers, preventing limb loss, improving patient function, quality of life and prolong overall survival. Prompt surgical or endovascular revascularization or a combination of techniques, is currently recommended as the optimal therapy for limb salvage in CLI [4-6]. The present article will focus on available evidence supporting medical interventions aimed at reducing high rates of cardiovascular events and death and improving CLI management and care. Adjunct pharma-cotherapy directed to optimize outcomes after revascularization procedures will also be re-viewed.
Risk Factor Modification and Medical Therapy …show more content…
Aggressive risk factor modification is the initial therapy of both intermittent claudication (IC) and CLI. Notable Class I recommendations include blood pressure control, use of aspirin or clopidogrel, and statins. It is also important to note that diabetes mellitus is an independent risk factor for am-putations in patients with CLI [7-8]. Therefore, hemoglobin AIC and regulation of blood glu-cose levels in diabetics are also of utmost importance [5, 9]. However, in contrast to IC, treatment of CLI warrants a more aggressive approach. The natural history of CLI and its grim prognosis mandates a more aggressive strategy and treatment of underlying ischemia. In addition, the evidence of the effectiveness of therapies such as aspirin to prevent cardiovascu-lar events is not sufficiently established and proven in CLI patients, except in PREVENT III trial (Project of Ex-Vivo vein graft Engineering via Transfection III) where in retrospective analysis of 1,404 CLI patients reported that use of statins did not alter operative outcomes but was associated with reduced 1-year mortality rate after surgical revascularization.