Critical Limb Ischemia: A Look-Back at a Year of Abundant Insights (Video)

2016 was a highly active year for research in critical limb ischemia (CLI), particularly for CLI expert Mehdi Shishehbor, DO, MPH, PhD, Director of Endovascular Services at Cleveland Clinic.

Dr. Shishehbor led teams that generated the following over the past year:

• A comprehensive analysis of a nationwide sample of nearly 650,000 hospitalized patients with CLI from 2003 to 2011. The paper, published in the Journal of the American College of Cardiology (and recapped here), outlined an abundance of trends in CLI management, including the fact that the decline in CLI surgeries is balanced by a rise in endovascular procedures for CLI.

• A substudy of the IN.PACT DEEP randomized trial suggesting that currently recommended hemodynamic measurements for diagnosing CLI fall short too often and should be supplemented by the more sensitive measure of toe pressure. The paper was published in the Journal of Vascular Surgery and recapped in this post.

• A retrospective analysis of CLI patients treated with endovascular therapy showing that most readmissions occur between 30 and 180 days after endovascular therapy for nonprocedural reasons and that unhealed wounds are independently associated with readmission. The study was published in the Journal of the American Heart Association.

• A retrospective study of CLI patients undergoing endovascular revascularization that focused on how time to wound healing impacts outcomes. The resulting paper in Annals of Vascular Surgery concluded that would healing should be achieved within three months to reduce risk of major amputation and within four months to reduce risk of major adverse limb events.

• An “expert statement” on CLI published in the Journal of the American College of Cardiology (JACC) that provides a state-of-the-art review of diagnostic assessment and analysis, endovascular versus open surgical treatment, regenerative and adjunctive therapies, and more.

In the two-minute video below, Dr. Shishehbor shares some takeaways from these emerging insights into CLI management, including the necessity of a truly multidisciplinary approach to care.

If you’d like a deeper dive into CLI care, check out this 20-minute video lecture by Dr. Shishehbor on the portion of his JACC expert statement devoted to post-revascularization management after intervention for CLI.