622:"A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial"
265:. A randomised trial involving people with chronic limb threatening ischaemia who needed revascularisation below the knee found that offering endovascular therapy first led to better outcomes (fewer deaths and amputations) than offering vein bypass first (among people who were eligible for both surgeries).
677:
Deev, Roman V; Bozo, Ilia Y; Mzhavanadze, Nina D; Voronov, Dmitriy A; Gavrilenko, Aleksandr V; Chervyakov, Yuriy V; Staroverov, Ilia N; Kalinin, Roman E; Shvalb, Pavel G; Isaev, Artur A (2015). "PCMV-vegf165 Intramuscular Gene
Transfer is an Effective Method of Treatment for Patients with Chronic
273:
As of 2015 pCMV-vegf165, a gene-therapy was being studied in critical limb ischemia. In 2014, a trial was started to better understand the best revascularization technique for CLI. As of 2017, it had enrolled nearly half of the 2100 people needed to complete the trial. A similar study, BASIL 2
721:
Menard, Matthew T; Farber, Alik; Assmann, Susan F; Choudhry, Niteesh K; Conte, Michael S; Creager, Mark A; Dake, Michael D; Jaff, Michael R; Kaufman, John A; Powell, Richard J; Reid, Diane M; Siami, Flora Sandra; Sopko, George; White, Christopher J; Rosenfield, Kenneth (2016).
619:
Bradbury, Andrew W; Moakes, Catherine A; Popplewell, Matthew; Meecham, Lewis; Bate, Gareth R; Kelly, Lisa; Chetter, Ian; Diamantopoulos, Athanasios; Ganeshan, Arul; Hall, Jack; Hobbs, Simon; Houlind, Kim; Jarrett, Hugh; Lockyer, Suzanne; Malmstedt, Jonas (2023-05-01).
224:
enables the visualization of regional blood flow using a charge-coupled camera. A 2016 study determined that it âis a valuable tool in visualizing real-time procedural outcomes and providing additionally useful information on regional tissue perfusion.â
228:
Biosensors measuring oxygen levels subcutaneously in the feet of CLI patients have been developed. Initial studies show these sensors may have value in predicting wound healing in CLI patients. One such sensing system, known as
332:
Mills, Joseph L; Conte, Michael S; Armstrong, David G; Pomposelli, Frank B; Schanzer, Andres; Sidawy, Anton N; Andros, George; Society for
Vascular Surgery Lower Extremity Guidelines Committee (2014).
595:
378:"Perfusion Assessment in Critical Limb Ischemia: Principles for Understanding and the Development of Evidence and Evaluation of Devices: A Scientific Statement From the American Heart Association"
172:
Critical limb ischemia is diagnosed by the presence of ischemic rest pain, and an ulcers that will not heal or gangrene due to insufficient blood flow. Insufficient blood flow may be confirmed by
376:
Misra, Sanjay; Shishehbor, Mehdi H.; Takahashi, Edwin A.; Aronow, Herbert D.; Brewster, Luke P.; Bunte, Matthew C.; Kim, Esther S.H.; Lindner, Jonathan R.; Rich, Kathleen (12 August 2019).
771:
Popplewell, Matthew A; Davies, Huw; Jarrett, Hugh; Bate, Gareth; Grant, Margaret; Patel, Smitaa; Mehta, Samir; Andronis, Lazaros; Roberts, Tracy; Deeks, Jon; Bradbury, Andrew (2016).
198:. Acute limb ischemia is a sudden lack of blood flow to the limb, for example caused by an embolus whereas critical limb ischemia is a late sign of a progressive chronic disease.
89:, CLI has a negative prognosis within a year after the initial diagnosis, with 1-year amputation rates of approximately 12% and mortality of 50% at 5 years and 70% at 10 years.
206:
Other diagnostic approaches for CLI under development or that have recently been introduced include different angiographic and imaging techniques, as well as the use of
334:"The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI)"
859:
1432:
659:
571:
1204:
1209:
596:"Profusa Receives CE Mark Approval to Market the Wireless LumeeÂŽ Oxygen Platform for Continuous, Real-Time Monitoring of Tissue Oxygen"
724:"Design and Rationale of the Best Endovascular Versus Best Surgical Therapy for Patients with Critical Limb Ischemia (BESTâCLI) Trial"
136:. It begins, or is aggravated, after reclining or elevating the limb and is relieved by sitting or standing. It is more severe than
177:
1359:
976:
773:"Bypass versus angio plasty in severe ischaemia of the leg - 2 (BASIL-2) trial: Study protocol for a randomised controlled trial"
991:
852:
1310:
77:. The latter two conditions are jointly referred to as tissue loss, reflecting the development of surface damage to the limb
183:
Other factors which may point to a diagnosis of critical limb ischemia are a
Buerger's angle of less than 20 degrees during
1122:
153:
1347:
1427:
1052:
474:"2D perfusion-angiography during endovascular intervention for critical limb threatening ischemia â A feasibility study"
70:
1442:
1437:
1164:
1154:
1543:
1194:
1169:
986:
915:
845:
1568:
1511:
1159:
1112:
962:
925:
246:
242:
161:
137:
86:
66:
1320:
1315:
1553:
1366:
1139:
1117:
427:"Assessment of foot perfusion: Overview of modalities, review of evidence, and identification of evidence gaps"
100:
has led to a broader conception of limb threat that includes the risk of amputation associated with severely
828:
1608:
1590:
1072:
1067:
1031:
1001:
1580:
1563:
1558:
1548:
1389:
1325:
967:
868:
141:
1633:
1585:
1330:
1189:
1181:
1149:
1036:
274:(Bypass Versus Angio plasty in Severe Ischaemia of the Leg), is being conducted in the United Kingdom.
1499:
1494:
1298:
1090:
173:
1575:
1342:
195:
217:, that allows measurement of parameters of contrast delivery to a region of interest in the foot.
1489:
1399:
981:
703:
454:
426:
1280:
1229:
1129:
804:
753:
695:
641:
552:
503:
446:
407:
355:
314:
250:
184:
97:
213:
2D perfusion imaging is a software analysis package that can be incorporated into a standard
1285:
934:
794:
784:
743:
735:
687:
633:
542:
534:
493:
485:
438:
397:
389:
345:
304:
188:
78:
1477:
1472:
1384:
1107:
1062:
942:
832:
254:
1526:
1376:
1239:
1199:
1134:
1095:
1006:
799:
772:
748:
723:
547:
522:
498:
473:
402:
377:
637:
1627:
1394:
1057:
660:"Arterial blockages below the knee: which treatment is best at restoring blood flow?"
458:
707:
572:"Profusa Lumee oxygen platform may improve clinical management of patients with CLI"
1535:
1447:
1262:
952:
895:
837:
393:
1600:
996:
621:
262:
258:
221:
1516:
1506:
1467:
1411:
1404:
1234:
789:
538:
350:
333:
309:
292:
93:
691:
645:
489:
442:
1270:
1011:
947:
903:
886:
881:
739:
233:
manufactured by
Profusa Inc, attained European Regulatory approval in 2020.
214:
207:
129:
101:
808:
757:
699:
556:
507:
450:
411:
359:
318:
17:
1484:
1086:
1023:
957:
908:
157:
82:
74:
176:(ABI), ankle pressure, toe-brachial index (TBI), toe systolic pressure,
523:"SPY technology as an adjunctive measure for lower extremity perfusion"
877:
1221:
825:
105:
1253:
133:
125:
841:
116:
Critical limb ischemia includes rest pain and tissue loss.
291:
Varu, Vinit N; Hogg, Melissa E; Kibbe, Melina R (2010).
191:
of more than 15 seconds or diminished or absent pulses.
92:
CLI was conceived to identify patients at high-risk for
680:
1599:
1534:
1525:
1460:
1420:
1375:
1279:
1261:
1252:
1220:
1180:
1085:
1045:
1022:
933:
924:
894:
876:
40:
35:
826:Cochrane Peripheral Vascular Diseases Review Group
85:. Compared to the other manifestation of PAD,
853:
8:
241:Treatment mirrors that of other symptoms of
180:(TcpO2 ), or skin perfusion pressure (SPP).
27:Advanced stage of peripheral artery disease
1531:
1433:Chronic cerebrospinal venous insufficiency
1258:
930:
891:
860:
846:
838:
32:
798:
788:
747:
728:Journal of the American Heart Association
546:
497:
401:
371:
369:
349:
308:
194:Critical limb ischemia is different from
261:, and in the case of tissue loss, wound
140:, which is also a pain in the legs from
283:
69:. It is defined as ischemic rest pain,
1205:Hereditary hemorrhagic telangiectasia
7:
1210:Generalized essential telangiectasia
96:, but the increasing prevalence of
44:Critical limb ischemia, limb threat
152:Tissue loss is the development of
124:Rest pain is a continuous burning
25:
178:transcutaneous oxygen measurement
51:Chronic limb threatening ischemia
36:Chronic limb threatening ischemia
1360:Cerebral venous sinus thrombosis
425:Rogerâs, R Kevin (May 2, 2020).
81:due to the most severe stage of
67:peripheral artery disease (PAD)
1311:Hepatic veno-occlusive disease
570:Hudson, Jocelyn (2020-01-30).
202:Emerging Diagnostic Approaches
1:
1123:Aneurysm of sinus of Valsalva
977:Monckeberg's arteriosclerosis
638:10.1016/s0140-6736(23)00462-2
472:Lundin, Niklas (April 2020).
154:arterial insufficiency ulcers
71:arterial insufficiency ulcers
1428:Chronic venous insufficiency
1053:Aortoiliac occlusive disease
394:10.1161/CIR.0000000000000708
1443:Inferior vena cava syndrome
1438:Superior vena cava syndrome
1165:Vertebral artery dissection
1155:Intracranial berry aneurysm
478:JRSM Cardiovascular Disease
338:Journal of Vascular Surgery
297:Journal of Vascular Surgery
65:), is an advanced stage of
1650:
1544:Hypertensive heart disease
1195:Arteriovenous malformation
1170:Familial aortic dissection
521:Colvard, Benjamin (2016).
1569:Renovascular hypertension
1512:Hepatic artery thrombosis
1160:Carotid artery dissection
1113:Abdominal aortic aneurysm
963:Intermittent claudication
926:Peripheral artery disease
790:10.1186/s13063-015-1114-2
539:10.1016/j.jvs.2016.01.039
351:10.1016/j.jvs.2013.08.003
310:10.1016/j.jvs.2009.08.073
245:, and includes modifying
243:peripheral artery disease
162:peripheral artery disease
138:intermittent claudication
87:intermittent claudication
1554:Hypertensive nephropathy
1367:Post-thrombotic syndrome
1348:PagetâSchroetter disease
1140:Coronary artery aneurysm
1118:Thoracic aortic aneurysm
692:10.1177/1074248415574336
490:10.1177/2048004020915392
443:10.1177/1358863X20909433
293:"Critical limb ischemia"
1609:Orthostatic hypotension
1591:White coat hypertension
1068:Fibromuscular dysplasia
1032:Carotid artery stenosis
740:10.1161/JAHA.116.003219
1581:Pulmonary hypertension
1564:Secondary hypertension
1559:Essential hypertension
1549:Hypertensive emergency
1390:Portacaval anastomosis
1326:Portal vein thrombosis
968:Critical limb ischemia
869:Cardiovascular disease
678:Lower Limb Ischemia".
142:arterial insufficiency
59:critical limb ischemia
1586:Systolic hypertension
1331:Renal vein thrombosis
1190:Arteriovenous fistula
1182:Vascular malformation
1150:Intracranial aneurysm
1037:Renal artery stenosis
1500:Paradoxical embolism
1495:Cholesterol embolism
1321:MayâThurner syndrome
1316:BuddâChiari syndrome
1299:Deep vein thrombosis
1294:primarily lower limb
1073:Raynaud's phenomenon
632:(10390): 1798â1809.
174:ankle-brachial index
1576:Benign hypertension
666:. 13 December 2023.
196:acute limb ischemia
1490:Pulmonary embolism
1400:Esophageal varices
1338:upper limb / torso
982:Arteriolosclerosis
831:2015-02-23 at the
344:(1): 220â34.e1â2.
112:Signs and symptoms
1621:
1620:
1617:
1616:
1461:Arteries or veins
1456:
1455:
1281:Venous thrombosis
1248:
1247:
1230:Cherry hemangioma
1130:Aortic dissection
1081:
1080:
916:Buerger's disease
431:Vascular Oncology
388:(12): e657âe672.
251:revascularization
98:diabetes mellitus
57:), also known as
48:
47:
30:Medical condition
16:(Redirected from
1641:
1532:
1343:Mondor's disease
1286:Thrombophlebitis
1259:
935:Arteriosclerosis
931:
892:
862:
855:
848:
839:
813:
812:
802:
792:
768:
762:
761:
751:
718:
712:
711:
674:
668:
667:
656:
650:
649:
616:
610:
609:
607:
606:
592:
586:
585:
583:
582:
567:
561:
560:
550:
518:
512:
511:
501:
469:
463:
462:
422:
416:
415:
405:
373:
364:
363:
353:
329:
323:
322:
312:
288:
189:capillary refill
104:and non-healing
94:major amputation
33:
21:
1649:
1648:
1644:
1643:
1642:
1640:
1639:
1638:
1624:
1623:
1622:
1613:
1595:
1521:
1478:Microangiopathy
1473:Macroangiopathy
1452:
1416:
1385:Gastric varices
1371:
1284:
1275:
1244:
1216:
1176:
1108:Aortic aneurysm
1094:
1077:
1063:Erythromelalgia
1041:
1018:
943:Atherosclerosis
920:
884:
872:
866:
833:Wayback Machine
822:
817:
816:
770:
769:
765:
720:
719:
715:
676:
675:
671:
658:
657:
653:
618:
617:
613:
604:
602:
594:
593:
589:
580:
578:
569:
568:
564:
520:
519:
515:
471:
470:
466:
424:
423:
419:
375:
374:
367:
331:
330:
326:
290:
289:
285:
280:
271:
255:vascular bypass
239:
204:
170:
150:
122:
114:
31:
28:
23:
22:
15:
12:
11:
5:
1647:
1645:
1637:
1636:
1626:
1625:
1619:
1618:
1615:
1614:
1612:
1611:
1605:
1603:
1597:
1596:
1594:
1593:
1588:
1583:
1578:
1573:
1572:
1571:
1561:
1556:
1551:
1546:
1540:
1538:
1529:
1527:Blood pressure
1523:
1522:
1520:
1519:
1514:
1509:
1504:
1503:
1502:
1497:
1492:
1482:
1481:
1480:
1475:
1464:
1462:
1458:
1457:
1454:
1453:
1451:
1450:
1445:
1440:
1435:
1430:
1424:
1422:
1418:
1417:
1415:
1414:
1409:
1408:
1407:
1402:
1397:
1387:
1381:
1379:
1377:Varicose veins
1373:
1372:
1370:
1369:
1364:
1363:
1362:
1352:
1351:
1350:
1345:
1335:
1334:
1333:
1328:
1323:
1318:
1313:
1303:
1302:
1301:
1290:
1288:
1277:
1276:
1274:
1273:
1267:
1265:
1256:
1250:
1249:
1246:
1245:
1243:
1242:
1240:Spider angioma
1237:
1232:
1226:
1224:
1222:Vascular nevus
1218:
1217:
1215:
1214:
1213:
1212:
1207:
1200:Telangiectasia
1197:
1192:
1186:
1184:
1178:
1177:
1175:
1174:
1173:
1172:
1167:
1162:
1157:
1152:
1142:
1137:
1135:Aortic rupture
1132:
1127:
1126:
1125:
1120:
1115:
1100:
1098:
1096:pseudoaneurysm
1083:
1082:
1079:
1078:
1076:
1075:
1070:
1065:
1060:
1055:
1049:
1047:
1043:
1042:
1040:
1039:
1034:
1028:
1026:
1020:
1019:
1017:
1016:
1015:
1014:
1009:
1007:Oxycholesterol
1004:
999:
994:
989:
979:
973:
972:
971:
970:
965:
960:
955:
950:
939:
937:
928:
922:
921:
919:
918:
913:
912:
911:
900:
898:
889:
874:
873:
867:
865:
864:
857:
850:
842:
836:
835:
821:
820:External links
818:
815:
814:
763:
734:(7): e003219.
713:
669:
651:
611:
587:
562:
533:(1): 195â201.
513:
464:
437:(3): 235â245.
417:
365:
324:
282:
281:
279:
276:
270:
267:
238:
235:
203:
200:
185:Buerger's test
169:
166:
149:
146:
121:
118:
113:
110:
46:
45:
42:
38:
37:
29:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
1646:
1635:
1632:
1631:
1629:
1610:
1607:
1606:
1604:
1602:
1598:
1592:
1589:
1587:
1584:
1582:
1579:
1577:
1574:
1570:
1567:
1566:
1565:
1562:
1560:
1557:
1555:
1552:
1550:
1547:
1545:
1542:
1541:
1539:
1537:
1533:
1530:
1528:
1524:
1518:
1515:
1513:
1510:
1508:
1505:
1501:
1498:
1496:
1493:
1491:
1488:
1487:
1486:
1483:
1479:
1476:
1474:
1471:
1470:
1469:
1466:
1465:
1463:
1459:
1449:
1446:
1444:
1441:
1439:
1436:
1434:
1431:
1429:
1426:
1425:
1423:
1419:
1413:
1410:
1406:
1403:
1401:
1398:
1396:
1395:Caput medusae
1393:
1392:
1391:
1388:
1386:
1383:
1382:
1380:
1378:
1374:
1368:
1365:
1361:
1358:
1357:
1356:
1353:
1349:
1346:
1344:
1341:
1340:
1339:
1336:
1332:
1329:
1327:
1324:
1322:
1319:
1317:
1314:
1312:
1309:
1308:
1307:
1304:
1300:
1297:
1296:
1295:
1292:
1291:
1289:
1287:
1282:
1278:
1272:
1269:
1268:
1266:
1264:
1260:
1257:
1255:
1251:
1241:
1238:
1236:
1233:
1231:
1228:
1227:
1225:
1223:
1219:
1211:
1208:
1206:
1203:
1202:
1201:
1198:
1196:
1193:
1191:
1188:
1187:
1185:
1183:
1179:
1171:
1168:
1166:
1163:
1161:
1158:
1156:
1153:
1151:
1148:
1147:
1146:
1143:
1141:
1138:
1136:
1133:
1131:
1128:
1124:
1121:
1119:
1116:
1114:
1111:
1110:
1109:
1105:
1102:
1101:
1099:
1097:
1092:
1088:
1084:
1074:
1071:
1069:
1066:
1064:
1061:
1059:
1058:Degos disease
1056:
1054:
1051:
1050:
1048:
1044:
1038:
1035:
1033:
1030:
1029:
1027:
1025:
1021:
1013:
1010:
1008:
1005:
1003:
1000:
998:
995:
993:
990:
988:
985:
984:
983:
980:
978:
975:
974:
969:
966:
964:
961:
959:
956:
954:
951:
949:
946:
945:
944:
941:
940:
938:
936:
932:
929:
927:
923:
917:
914:
910:
907:
906:
905:
902:
901:
899:
897:
893:
890:
888:
883:
879:
875:
870:
863:
858:
856:
851:
849:
844:
843:
840:
834:
830:
827:
824:
823:
819:
810:
806:
801:
796:
791:
786:
782:
778:
774:
767:
764:
759:
755:
750:
745:
741:
737:
733:
729:
725:
717:
714:
709:
705:
701:
697:
693:
689:
686:(5): 473â82.
685:
681:
673:
670:
665:
664:NIHR Evidence
661:
655:
652:
647:
643:
639:
635:
631:
627:
623:
615:
612:
601:
597:
591:
588:
577:
576:Vascular News
573:
566:
563:
558:
554:
549:
544:
540:
536:
532:
528:
524:
517:
514:
509:
505:
500:
495:
491:
487:
483:
479:
475:
468:
465:
460:
456:
452:
448:
444:
440:
436:
432:
428:
421:
418:
413:
409:
404:
399:
395:
391:
387:
383:
379:
372:
370:
366:
361:
357:
352:
347:
343:
339:
335:
328:
325:
320:
316:
311:
306:
303:(1): 230â41.
302:
298:
294:
287:
284:
277:
275:
268:
266:
264:
260:
256:
252:
248:
244:
236:
234:
232:
231:Lumee Oxygen,
226:
223:
220:Fluorescence
218:
216:
211:
209:
201:
199:
197:
192:
190:
186:
181:
179:
175:
167:
165:
163:
159:
155:
147:
145:
143:
139:
135:
131:
127:
119:
117:
111:
109:
107:
103:
99:
95:
90:
88:
84:
80:
76:
72:
68:
64:
60:
56:
52:
43:
39:
34:
19:
1634:Hypertension
1536:Hypertension
1448:Venous ulcer
1354:
1337:
1305:
1293:
1263:Inflammation
1144:
1103:
992:Hyperplastic
953:Fatty streak
896:Inflammation
780:
776:
766:
731:
727:
716:
683:
679:
672:
663:
654:
629:
625:
614:
603:. Retrieved
599:
590:
579:. Retrieved
575:
565:
530:
526:
516:
481:
477:
467:
434:
430:
420:
385:
381:
341:
337:
327:
300:
296:
286:
272:
247:risk factors
240:
230:
227:
219:
212:
205:
193:
182:
171:
151:
123:
115:
91:
62:
58:
54:
50:
49:
1601:Hypotension
1145:head / neck
997:Cholesterol
887:capillaries
527:J Vasc Surg
382:Circulation
263:debridement
259:angioplasty
222:angiography
148:Tissue loss
41:Other names
18:Tissue loss
1517:Vasculitis
1507:Thrombosis
1468:Angiopathy
1412:Varicocele
1405:Hemorrhoid
1235:Halo nevus
1091:dissection
882:arterioles
626:The Lancet
605:2023-09-01
581:2023-09-01
278:References
208:biosensors
1271:Phlebitis
1012:Trans fat
948:Foam cell
904:Arteritis
871:(vessels)
646:0140-6736
459:218490284
237:Treatment
215:angiogram
168:Diagnosis
130:lower leg
120:Rest pain
1628:Category
1485:Embolism
1087:Aneurysm
1024:Stenosis
958:Atheroma
909:Aortitis
878:Arteries
829:Archived
809:26739146
758:27402237
708:13443907
700:25770117
600:BioSpace
557:26994959
508:32284859
451:32362209
412:31401843
360:24126108
319:20117502
269:Research
158:gangrene
102:infected
83:ischemia
75:gangrene
1306:abdomen
987:Hyaline
800:4704263
749:5015366
548:6706067
499:7133075
403:7372288
160:due to
128:of the
807:
797:
783:: 11.
777:Trials
756:
746:
706:
698:
644:
555:
545:
506:
496:
457:
449:
410:
400:
358:
317:
106:wounds
79:tissue
73:, and
1421:Other
1254:Veins
1104:torso
1046:Other
704:S2CID
455:S2CID
1355:head
885:and
805:PMID
754:PMID
696:PMID
642:ISSN
553:PMID
504:PMID
447:PMID
408:PMID
356:PMID
315:PMID
253:via
187:, a
134:feet
126:pain
55:CLTI
1002:LDL
795:PMC
785:doi
744:PMC
736:doi
688:doi
634:doi
630:401
543:PMC
535:doi
494:PMC
486:doi
439:doi
398:PMC
390:doi
386:140
346:doi
305:doi
257:or
156:or
132:or
63:CLI
1630::
1106::
1089:/
880:,
803:.
793:.
781:17
779:.
775:.
752:.
742:.
730:.
726:.
702:.
694:.
684:20
682:.
662:.
640:.
628:.
624:.
598:.
574:.
551:.
541:.
531:64
529:.
525:.
502:.
492:.
484:.
480:.
476:.
453:.
445:.
435:25
433:.
429:.
406:.
396:.
384:.
380:.
368:^
354:.
342:59
340:.
336:.
313:.
301:51
299:.
295:.
249:,
210:.
164:.
144:.
108:.
1283:/
1093:/
861:e
854:t
847:v
811:.
787::
760:.
738::
732:5
710:.
690::
648:.
636::
608:.
584:.
559:.
537::
510:.
488::
482:9
461:.
441::
414:.
392::
362:.
348::
321:.
307::
61:(
53:(
20:)
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.