Endovascular treatment of infra-popliteal arteries in patients with critical limb ischemia

Currently, critical limb ischemia occurs in an ageing population with more and more diabetic patients and infra-popliteal lesions. In order to be as little invasive as possible, endovascular techniques have been proposed as one of the best options for these patients. In the following review, we present the specificities and assess the clinical effectiveness of endovascular treatment for infra-popliteal lesions in critical limb ischemia. We undertook a literature review based on publications dealing with critical limb ischemia and infra-popliteal endovascular treatment and published during the last decade. All relevant studies were systematically reviewed. The recorded outcomes were : immediate technical success, peri-operative complications, 30-day mortality, primary and secondary patency, limb salvage, and patient survival. Thirty-one studies including a total of 3164 patients (range : 13 to 993) were included in this review. Technical success rates ranged between 72% and 100%. Peri-operative complications rates ranged between 0% and 16%, most complications being considered as minor. 30-day mortality rates ranged between 0% and 5%. Primary, secondary patency and limb salvage rates were respectively about 60%, 65%, and 85%. One-year survival was about 80%. In conclusion, endovascular treatment can be considered as a good option for the treatment of infra-popliteal lesions in critical limb ischemia. Despite the non entirely satisfactory patency rates, endovascular treatment may provide wound healing and limb salvage.