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Table 16. Factors That May Influence Revascularization
Strategy for CLTI
Factors That May
Influence Optimal
Revascularization
Modality Clinical Examples (Other Factors Being Equal)
Anatomy Strategy for current revascularization considers history of failed
previous revascularization procedures (surgical, endovascular, or both)
Anatomic characteristics that may favor surgical revascularization
include:
• Lesions involving both the common femoral artery and origin of
the profunda femoris artery
• Multilevel chronic total occlusions
• Lesions in which endovascular treatment would adversely impact
future surgical bypass options
• Lesions that are long segment, involving the below-knee popliteal
and infrapopliteal arteries
Available conduit Absence of suitable autogenous vein (eg, due to previous harvest
for coronary artery bypass surgery) may favor endovascular
revascularization.
Patient
comorbidities
High estimated perioperative risk (eg, coronary ischemia,
cardiomyopathy and heart failure, severe lung disease, CKD, and
frailty) may favor endovascular revascularization.
Patient preferences Patient preference for 1 revascularization modality (surgical
or endovascular) over the other, aer participating in shared
decision-making.
Modified with permission from Gerhard-Herman MD, et al. Copyright © 2017 American
Heart Association, Inc., and American College of Cardiolog y Foundation.
