The contribution of radiological investigation and treatment in the management of the critically ischemic lower limb is reviewed. The methods of classifying and assessing the cause, level, and severity of the arterial disease causing the ischemia are discussed with comparison of the relative merits of the various invasive and noninvasive techniques of investigation. The development of the methods of interventional radiological management is described with an indication of the relative success of the different techniques. Newer interventional developments, including intravascular brachytherapy and gene therapy are discussed.
Fontaine R, Kim M, Kieny R.Die chirurgische Behandlung der peripheren Durchblutungsstörung. Helv Chir Acta5/61954;199-233.
3.
Rutherford RB, Baker JD, Ernst C, et al.Recommended standards for reports dealing with lower extremity ischaemia; Revised version. J Vasc Surg1997;26:517-538.
4.
Second European consensus document on chronic critical limb ischaemia. Circulation1991;84(IV):1-26.
5.
Ubbink DT, Tulevski II, den Hartog D, et al.The value of noninvasive techniques for the assessment of critical limb ischaemia. Eur J Vasc Endovasc Surg1997;13;296-300.
6.
Kram HB, Paul L, Appel MPA, et al.Multisensor transcutaneous oximetric mapping to predict below knee amputation wound healing: use of a critical PO2. J Vasc Surg1989;9:796-800.
7.
Reiber GE, Pecoraro RE, Koepsel TD.Risk factors for amputation in patients with diabetes mellitus. Ann Intern Med1992;117:97-105.
8.
Didier D, Costes Y.Transcutaneous PO2 (TcPO2) monitoring during iliac and femoral percutaneous transluminal angioplasties (PTA). J Intervent Radiol1992;7:7-20.
9.
Cisek PL, Eze AR, Comerota AJ, et al.Microcirculatory compensation to progressive atherosclerotic disease. Ann Vasc Surg1997;11:49-53.
10.
Castronuovo JJ Jr, Adera HM, Smiell JM, et al.Skin perfusion pressure measurement is valuable in the diagnosis of critical limb ischaemia. J Vasc Surg1997;26:629-637.
11.
Shearman CP, Gwynn BR, Curran F, et al.Non-invasive femoropopliteal assessment: is that angiogram really necessary?BMJ1986;293:1086-1089.
12.
Pemberton M, London NJM. Colour flow duplex imaging of occlusive arterial disease of the lower limb. BJS1997;84:912-919.
13.
Rofsky NM, Adelman MA.MR angiography in the evaluation of atherosclerotic peripheral vascular disease. Radiology2000;214:325-338.
14.
TransAtlantic InterSociety Consensus (TASC) document on management of peripheral arterial disease. J Vasc Surg2000;31:S1-S296.
15.
Dotter CT, Judkins MP.Transluminal treatment of arteriosclerotic obstruction. Description of a new technique and a preliminary report of its application. Circulation1964;30:654-670.
16.
Grüntzig A, Hopff H.Perkutane Rekanalisation chronischer arterieller Verschlusse mit einem neuen Dilatationskatheter. Modifikation der Dotter-Technik. Dtsch med Wschr1974;99:2502-2505.
17.
Johnstone KW, Rae M, Hogg-Johnston SA, et al.5-year results of a prospective study of percutaneous transluminal angioplasty. Ann Surg1987;206:403-413.
18.
Lammer J.Femoropopliteal artery obstructions: from the balloon to the stent-graft. Cardiovasc Intervent Radiol2001;24:73-83.
19.
Hartnell G, Wakeley C, Wyatt M, et al.Is iliac angioplasty indicated in the treatment of critical limb ischaemia?J Intervent Radiol1992;7:101-103.
20.
Schwarten DE, Cutcliff WB.Arterial occlusive disease below the knee: treatment with percutaneous transluminal angioplasty performed with low-profile catheters and guide wires. Radiology1988;169:71-74.
21.
Lofberg AM, Lorelius LE, Karacagil S, Westman B, Almgren B, Berqgvist D.The use of below-knee percutaneous transluminal angioplasty in arterial occlusive disease causing chronic critical limb ischaemia. Cardiovasc Intervent Radiol1996;19:317-322.
22.
Watson HR, Schroeder TV, Simms MH, et al.Relationship of femorodistal bypass patency to clinical outcome. Eur J Vasc Endovasc Surg1999;17:77-83.
23.
Bolia A, Miles KA, Brennan J, et al.Percutaneous transluminal angioplasty of occlusions of the femoral and popliteal arteries by subintimal dissection. Cardiovasc Intervent Radiol1990;13:357-363.
24.
London NJM, Srinivan R, Naylor AR, et al.Subintimal angioplasty of femoropopliteal artery occlusions: the long-term results. Eur J Vasc Surg1994;8:148-155.
25.
Matsi PJ, Manninen HI, Vanninen RL, et al.Femoropopliteal angioplasty in patients with claudication: primary and secondary patency in 140 limbs with 1-3 year follow up. Radiology1994;191:727-733.
26.
Nydahl S, Hartshorne T, Bell PR, et al.Subintimal angioplasty of infra popliteal occlusions in critically ischaemic limbs. Eur J Vasc Endovasc Surg1997;14:212-216.
27.
Nydahl S, London NJM, Bolia A.Limb salvage by infrapopliteal subintimal percutaneous transluminal angioplasty after failed femorodistal bypass. J Intervent Radiol1999;14:83-85.
28.
Belli A-M, Cumberland DC, Procter AE, et al.Follow-up of conventional versus laser thermal percutaneous angioplasty of total femoropopliteal artery occlusions: results of a randomised trial. J Vasc Intervent Radiol1992;2:485-488.
29.
Triller J, Do DD, Maddern G, et al.Femoropopliteal artery occlusion: clinical experience with a Kensey catheter. Radiology1992;182:257-261.
30.
Girolami B, Bernardi E, Prins MH, et al.Antiplatelet therapy and other interventions after revascularisation procedures in patients with peripheral vascular disease: a meta-analysis. Eur J Vasc Surg2000;19:370-380.
31.
Robless P, Mikhailidis DP, Stansby G.Systematic review of antiplatelet therapy for the prevention of myocardial infarction, stroke or vascular death in patients with peripheral vascular disease. BJS2001;88:787-800.
32.
Henry M, Amor M, Ethevenot G, et al.Palmaz stent placement in iliac and femoropopliteal arteries: primary and secondary patency in 310 patients with 2-4 year follow-up. Radiology1995;197:167-174.
33.
Tetteroo E, van der Graaf Y, Bosch JL, et al. for the Dutch Iliac Stent Trial Study Group. Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac-artery occlusive disease. Lancet1998;351:1153-1159.
Richter GM, Palmaz JC, Noeldge G, et al.Relationship between blood flow, thrombus, and neointima in stents. J Vasc Intervent Radiol1999;10:598-604.
36.
Ellis SG. The ERASOR investigators. Acute platelet inhibition with Abciximab does not reduce in-stent restenosis (ERASER study). Circulation1001999:799-806.
37.
Vroegindeweij D, Vos LD, Tielbeek AV, et al.Balloon angioplasty combined with primary stenting versus balloon angioplasty alone in femoropopliteal obstructions: a comparative randomised study. Cardiovasc Intervent Radiol1997;20:420-425.
38.
Cejna M, Thurnher S, Illiasch H, et al.Percutaneous transluminal angioplasty (PTA) versus Palmaz stent placement in femoropopliteal artery obstruction: a multicenter prospective randomised study. J Vasc Intervent Radiol2001;12:23-31.
39.
Lammer J, Dake MD, Bleyn J, et al.Peripheral arterial obstruction: prospective study of treatment with a transluminally placed self-expanding stent-graft. Radiology2000;217:95-104.
40.
Drachman DE, Edelman ER, Seifert P, et al.Neointimal thickening after stent delivery of paclitaxel: change in composition and arrest of growth over six months. J Am Coll Cardiol2000;36:2325-2332.
41.
Grube E, Gerckens U, Rowold S, et al.Inhibition of in-stent restenosis by the Quanam drug eluting polymer stent: two year follow-up. J Am Coll Cardiol2001;37:74a (abstract).
42.
Sousa JE, Costa MA, Abizaid A, et al.Lack of neo-intimal proliferation after implantation of Sirolimus-coated stents in human coronary arteries: a quantative coronary angiography and three-dimensional intravascular ultrasound study. Circulation2001;103:192-195.
43.
Minar E, Pokrajac B, Maca T, et al.Endovascular brachytherapy for prophylaxis of restenosis after femoropopliteal angioplasty: results of a prospective randomised study. Circulation2000;102:2694-2699.
44.
Waksman R.INHIBIT Trial (Intimal Hyperplasia Inhibition with Beta In-stent Trial). Clinical and angiographic results of the multicenter, randomised, double-blind study. Circulation2000;102(18, Suppl II):667 (abstract).
45.
Leon MB, Teirstein PS, Moses JW, et al.Localized intra-coronary gamma-radiation therapy to inhibit the recurrence of restenosis after stenting. N Engl J Med2001;344:250-256.
46.
Wardeh AJ, Kay IP, Sabaté M, et al.B-particle emitting radioactive stent implantation: a safety and feasibility study. Circulation1999;100:1684-1689.
47.
Teirstein PS, Massullo V, Jani S, et al.Three-year clinical and angiographic follow-up after intracoronary radiation. Results of a randomised clinical trial. Circulation2000;101:360-365.
48.
Kay IP, Wardeh AJ, Kozuma K, et al.Radioactive stents delay but do not prevent in-stent neointimal hyperplasia. Circulation2001;103:14-17.
49.
Luo Z, Asahara T, Isner JM, et al.Reduction of vein graft intimal hyperplasia and preservation of endothelium-dependent relaxation by topical vascular endothelial growth factor. J Vasc Surg1998;27:167-173.
50.
Amant C, Berthou L, Walsh K.Angiogenesis and gene therapy in man. Dream or reality?Drugs1999;58:37-41.
