21
Table 31. Therapy for CLI: Findings That Prompt
Consideration of Surgical or Endovascular
Revascularization
Findings That Favor Consideration of
Surgical Revascularization Examples
Factors associated with technical failure
or poor durability with endovascular
treatment
Lesion involving common femoral artery,
including origin of deep femoral artery
Long segment lesion involving the below-
knee popliteal and/or infrapopliteal arteries
in a patient with suitable single-segment
autogenous vein conduit
Diffuse multilevel disease that would
require endovascular revascularization at
multiple anatomic levels
Small-diameter target artery proximal to
site of stenosis or densely calcified lesion at
location of endovascular treatment
Endovascular treatment likely to preclude
or complicate subsequent achievement
of in-line blood flow through surgical
revascularization
Single-vessel runoff distal to ankle
Findings That Favor Consideration of
Endovascular Revascularization Examples
The presence of patient comorbidities
may place patients at increased risk of
perioperative complications from surgical
revascularization. In these patients, an
endovascular-first approach should be
used regardless of anatomy
Patient comorbidities, including coronary
ischemia, cardiomyopathy, congestive heart
failure, severe lung disease, and chronic
kidney disease
Patients with rest pain and disease at
multiple levels may undergo a staged
approach as part of endovascular-first
approach
In-flow disease can be addressed first, and
out-flow disease can be addressed in a staged
manner, when required, if clinical factors or
patient safety prevent addressing all diseased
segments at one setting.
Patients without suitable autologous vein
for bypass grafts
Some patients have had veins harvested for
previous coronary artery bypass surgery
and do not have adequate remaining veins
for use as conduits. Similarly, patients may
not have undergone prior saphenous vein
harvest, but available vein is of inadequate
diameter.
