It is our pleasure to present the annual critical limb ischemia (CLI) edition of Endovascular Today. This year, we aim for a broad review of the landscape, zooming out from procedural and technologic specifics to encapsulate where we stand as a whole. To this end, we have invited key voices from around the globe and multiple specialties to address key themes concerning CLI patient management.

We begin with a focus on the emerging body of clinical evidence in CLI therapy. First, a comprehensive overview of clinical trials in the lower extremities with specific focus on CLI is provided by Bram Fioole, MD; Joost A. Bekken, MD; and Hence Verhagen, MD. Next, an overview of the German CRITISCH trial is shared by Theodosios Bisdas, MD; Giovanni Torsello, MD; and Konstantinos Stavroulakis, MD. To close out this section, trialists Matthew Menard, MD; Alik Farber, MD; and Kenneth Rosenfield, MD, provide an update on the progress of the currently enrolling BEST-CLI trial. These data (along with those from BASIL-3 and SWEDEPAD, which are currently halted pending the outcomes of investigations into paclitaxel safety) should help to further structure our understanding of long-term outcomes in this challenging population.

Next, we transition into various practical aspects of CLI patient management. Fadi Saab, MD; Bret N. Wiechmann, MD; and Christopher LeSar, MD, begin by addressing the specific elements needed to provide high-level care for CLI patients, especially when performed in an outpatient setting. Next, an expert panel discussion with John A. Phillips, MD; Saher Sabri, MD; Ramon L. Varcoe, PhD; Sabine Steiner, MD; and Osamu Iida, MD, shares tips to enhance technical success when attempting to cross chronic total occlusions.

An interview with Heather L. Gornik, MD, provides insights into the most recent advances in medical therapy and touches upon the areas where evidence and understanding are still developing. Richard F. Neville, MD, discusses the role of bypass surgery for CLI in the endovascular era, emphasizes the importance of communication between various specialties involved in the management of CLI, and also expresses a word of caution on not being too aggressive and invasive in treating patients with intermittent claudication. Another expert panel discussion includes John H. Rundback, MD; Marianne Brodmann, MD; Misaki Kiguchi, MD; and Thomas Zeller, MD, who share their thoughts on CLI surveillance protocols and which findings during follow-up will trigger planning of a reintervention. This discussion provides insight into an area in which guidelines are currently lacking while also demonstrating differences in practice throughout the world.

On behalf of the CLI Global Society, Jihad A. Mustapha, MD; Barry T. Katzen, MD; Richard F. Neville, MD; Robert A. Lookstein, MD; Thomas Zeller, MD; Larry E. Miller, PhD; Vickie R. Driver, DPM; and Michael R. Jaff, DO, emphasize the importance of increasing CLI awareness, not only for health care providers, but also patients and (political) decision makers.

This issue would not be complete without a word on the current scrutiny regarding paclitaxel-eluting technology. An interview with FDA representatives gives a preview on the agency’s upcoming panel exploring the long-term safety of these devices.

The issue concludes with an interview with Tilo Kölbel, MD, who discusses the prevention of stroke and spinal cord ischemia in endovascular interventions, his protocols for intervening on aortic dissections, and more.

We have once more enjoyed preparing and editing this issue and are grateful to all of the esteemed participants. We hope it helps you in optimizing care for patients with CLI.

Jos C. van den Berg, MD, PhD
Jihad A. Mustapha, MD
Guest Chief Medical Editors