الفهرس 
ANATOMY OF LOWER LIMB ARTERIALOnly 14 pages are availabe for public view
 |  | from | 124 |  |  |
| | | from | 124 | | |
Abstract
Critical limb ischemia (CLI) is estimated to develop in 500 to 1000 individuals per million persons per year in the general populations. CLI has important functional implications and a major impact on the quality of life. The quality of life indices of patients with CLI have been reported to be similar to those of terminal cancer patients.
Distal bypass for limb salvage with autogenous conduit is an excellent option for patients who are good candidates for surgical revascularization. However, a large number of patients with critical lower limb ischemia are not eligible for these revascularization procedures because of absence or poor distal run off which make surgical revascularization difficult.
Medical treatment is required to control pain and infection in the ischemic leg, prevention of progression of atherosclerosis, and optimization of cardiac and respiratory function. New modality of pharmacotherapy treatment is using prostanoids like PGE1 and PGI2 analog. Although some studies suggested improved healing of ischemic ulcers and reduction in amputations but recent trials do not support the benefit of prostanoids in promoting amputation-free survival.
Recent advances in endovascular interventions have made this minimally invasive approach an important alternative in the treatment of lower extremity occlusive disease. However, despite rapidly evolving endovascular technology, lower-extremity endovascular intervention continues to be one of the most controversial and challenging areas of therapeutic strategy.
Subintimal Angioplasty offers a vastly increased scope of treatment where conventional Intraluminal angioplasty would not be applicable like in long standing occlusions which have become hard with time where Intraluminal approach would fail or Long segment occlusions where it is difficult to maintain an Intraluminal approach. It has been used widely recently with clinical success rate reaching about 70% and limb salvage rate about 80% to 90%.
Therapeutic angiogenesis / vasculogenesis represent a new approach for treating patients with ischemic disease not curable with conventional treatment. Manipulation of the angiogenesis program and transplantation of progenitor cells is hoped to overcome endogenous liabilities that impede appropriate healing in atherosclerotic or diabetic patients.
Autologous stem cell-based therapy offers many advantages over other nonsurgical treatments of peripheral arterial disease. Autologous stem cells were extracted and injected in the ischemic limb. There is improvement in symptoms, healing of ulcers and decrease rest pain. However stem cell transplantation cannot be used widely due to high cost of the procedure and the requirement of special equipment and expert staff.
Amputation often viewed as a failure of treatment but it should be considered an important, definitive treatment option. The goal of amputation is to remove all infected, gangrenous, and ischemic tissue and provide the patient with the longest functional limb. Avoidance of repeated amputations and non healing operative sites is crucial for the patient’s optimal recovery and best functional rehabilitation or palliation.