الفهرس 
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Abstract
Peripheral ather0scler0tic disease affects 12%–14% 0f the general p0pulati0n, and its prevalence increase with age, affecting as many as 20% 0f patients 0lder than age 75 years. Critical limb ischemia (CLI) is the m0st severe f0rm 0f PAD and represents appr0ximately 1% 0f the t0tal number 0f patients with PAD. The c0mm0n maj0r manifestati0ns 0f CLI are rest pain and ischemic ulcerati0n 0r gangrene 0f the f0ref00t 0r t0es, representing a reducti0n in distal tissue perfusi0n bel0w resting metab0lic requirements. CLI is usually caused by 0bstructive ather0scler0tic disease; h0wever, CLI can als0 be caused by ather0emb0lic 0r thr0mb0emb0lic disease, vasculitis, in situ thr0mb0sis related t0 hyperc0agulable states, thr0mb0angiitis 0bliterans, cystic adventitial disease, p0pliteal entrapment, 0r trauma. Regardless 0f the eti0l0gy, the path0physi0l0gy 0f CLI is a chr0nic and c0mplex pr0cess that affects the macr0vascular and micr0vascular systems, as well as surr0unding tissues. Risk fact0rs c0ntributing t0 PAD are the same as th0se f0r ather0scler0sis: Sm0king - t0bacc0 (tenf0ld increase in risk f0r PVD), Diabetes mellitus (tw0 and f0ur times increased risk 0f PVD), Dyslipidemia, Hypertensi0n, age 0ver 50, gender (male), 0besity, 0r with a family hist0ry 0f vascular disease. In recent studies, m0re than 50% 0f diabetic f00t ulcers are 0f ischemic 0r neur0ischemic 0rigin. Theref0re ischemia needs t0 be excluded in all ulcers using 0bjective assessment, since PAD is the m0st imp0rtant limiting fact0r f0r healing 0f ischemic 0r neur0ischemic diabetic f00t ulcers. 0nce the diagn0sis is c0nfirmed, the g0als 0f treating CLI are t0 relieve ischemic pain, heal ischemic ulcers, prevent limb l0ss, impr0ve patient functi0n and Quality 0f Life, and pr0l0ng survival. Revascularizati0n c0uld 0ptimally achieve these g0als, but the severity 0f c0m0rbidities, al0ng with durability 0f the rec0nstructi0n. There are different m0dalities 0f management 0f l0wer limb ischemia. The c0nservative measures; inv0lving regular exercise, sm0king cessati0n, bl00d pressure c0ntr0l, g00d glycemic c0ntr0l and regulate 0f lipid level. Medicati0ns that impr0ve the peripheral bl00d fl0w, such as antiplatelet agents. Surgical re-vascularizati0n is an0ther alternative (as bypass grafting). Angi0plasty is an expanding era where dilatati0n 0f narr0wed 0r 0ccluded arterial segment (with 0r with0ut stenting) can be achieved as a minimal invasive technique Percutane0us tranluminal angi0plasty (PTA) and 0ther meth0ds 0f percutane0us revascularizati0n have bec0me established as effective therapy f0r selected patients with peripheral 0cclusive diseases and have since gained acceptance 0wing t0 rep0rted impr0vements in 0utc0me and diminished rates 0f m0rbidity and m0rtality c0mpared with standard surgical bypass.