Below-the-Knee Endovascular Revascularization: A Position Statement

Jun Li; Ramon Varcoe; Marco Manzi; Steven Kum; Osamu Iida; Andrej Schmidt; Mehdi H Shishehbor

doi:10.1016/j.jcin.2023.11.040

Below-the-Knee Endovascular Revascularization: A Position Statement

JACC Cardiovasc Interv. 2024 Mar 11;17(5):589-607. doi: 10.1016/j.jcin.2023.11.040. Epub 2024 Jan 17.

Authors

Jun Li¹, Ramon Varcoe², Marco Manzi³, Steven Kum⁴, Osamu Iida⁵, Andrej Schmidt⁶, Mehdi H Shishehbor⁷

Affiliations

¹ University Hospitals Harrington Heart and Vascular Institute, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
² Prince of Wales Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
³ Interventional Radiology Unit, Foot and Ankle Clinic, Policlinico Abano Terme, Abano Terme, Italy.
⁴ Department of Surgery, Changi General Hospital, Singapore.
⁵ Kasai Rosai Hospital Cardiovascular Center, Amagasaki, Japan.
⁶ Division of Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany.
⁷ University Hospitals Harrington Heart and Vascular Institute, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Electronic address: Mehdi.shishehbor@uhhospitals.org.

PMID: 38244007
DOI: 10.1016/j.jcin.2023.11.040

Abstract

Patients with chronic limb-threatening ischemia, the terminal stage of peripheral artery disease, are frequently afflicted by below-the-knee disease. Although all patients should receive guideline-directed medical therapy, restoration of inline flow is oftentimes necessary to avoid limb loss. Proper patient selection and proficiency in endovascular techniques for below-the-knee revascularization are intended to prevent major amputation and promote wound healing. This review, a consensus among an international panel of experienced operators, provides guidance on these challenges from an endovascular perspective and offers techniques to navigate this complex disease process.

Keywords: CLTI; below the knee; chronic limb-threatening ischemia; endovascular revascularization.

Publication types

Review

MeSH terms

Chronic Disease
Endovascular Procedures* / adverse effects
Endovascular Procedures* / methods
Humans
Ischemia / diagnostic imaging
Ischemia / therapy
Limb Salvage
Lower Extremity / blood supply
Peripheral Arterial Disease* / diagnostic imaging
Peripheral Arterial Disease* / therapy
Retrospective Studies
Risk Factors
Treatment Outcome