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J.Jpn. Surg. Soc.. 108(4): 181-185, 2007

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Hakuaikai Hospital, Gifu, Japan

Junichi Matsubara

The treatment of critical limb ischemia (CLI), which is the end stage of arteriosclerosis obliterans and/or Buerger's disease, provides the ischemic tissue with oxygen, and arterial revascularization procedures such as bypass surgery and thromboendarterectomy, percutaneous transluminal angioplasty (PTA)/stent, sympathectomy, hyperbaric oxygenation, angiogenesis, medical treatment, etc. are performed. Successful bypass surgery on the crural and foot arteries is the most effective procedure, although it requires good skill and an autogenous vein of good quality. The results of thromboendarterectomy for the femoral artery are not sufficient and thromboendarterectomy for below-knee arteries is impossible. PTA/stent is the first choice of treatment for iliac arterial lesions. It is, however, not appropriate for below-knee arteries. Recently, many interventionists perform intraarterial treatment, although the intervention approved only because stenosis and/or occlusion is noted in the arteriogram. A correct diagnosis of the clinical severity of CLI in the leg is important for appropriate treatment. Sympathectomy of the lower limb is often effective in Buerger's disease.
Hyperbaric oxygenation of the whole body is not currently performed.
Angiogenesis is a new method, still in the experimental stage and its clinical effectiveness has not been confirmed.
Anticoagulants, prostanoids, and antiplatelets are always necessary in the treatment of CLI.

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