Chief Medical Editor's Page
Exploring Your Options
This issue of Endovascular Today addresses an important clinical problem: the treatment of acute limb ischemia. Acute limb ischemia represents one of the great challenges to all vascular therapists, because it threatens not only limb but also life, depending on the choice of medical therapy. Mortality risks associated with surgical reperfusion have been reported at 9.7% to 17%, and as high as 42% in groups of elderly patients.
Although acute limb ischemia can be caused by a host of diseases that are not atherosclerotic, most often atherosclerosis is the principal cause in association with thrombosis.
In the early ‘70s, the beginnings of a change in approach to limb ischemia began when Dotter initially described the concept of catheter-directed thrombolysis. The ability to induce lysis of clots by activating agents within the thrombus and, at least in theory, reducing the risk of systemic thrombolytic effects, offered great promise.
Over the next several decades, the use of thrombolytic agents became an integral part of the vascular interventionalists’ armamentarium, as more and more patients with thrombosis and acute limb ischemia were treated utilizing endovascular techniques. The application of this technology has grown to include management of arterial and venous thrombus, as well as thrombus associated with dialysis access grafts.
In the past decade, a number of mechanical devices have been developed to accelerate the ability to obtain reperfusion and in some cases widen the use of adjunctive thrombolysis altogether.
Finally, surgical revascularization in acute limb ischemia remains a critical tool necessary for reperfusion in many patients.
We are privileged to have three highly experienced contributors discussing each of these important approaches to acute limb ischemia: thrombolytic therapy, use of mechanical devices, and surgical revascularization.
Although there is much agreement on the importance of early diagnosis and treatment of acute limb ischemia, which tools should be employed first remains somewhat controversial and may vary from institution to institution.
Hopefully, this month’s issue will assist readers in making their own decisions.