Chronic Limb-Threatening Ischemia: Redefining the landscape

Abstract

Peripheral arterial disease (PAD) is one of the three major clinical manifestations of atherosclerosis, the other two being coronary artery (CAD) and cerebrovascular disease. This thesis provides an overview of the management and prognosis of PAD and more specifically chronic limb-threatening ischemia (CLTI). This thesis aimed to contribute to improved definition, classification, prognostic modeling, and clinical decision making in CLTI patients and is divided in three main topics. Part 1 and 2 focus on the validation and improvement within two pillars of the “PLAN” concept of evidence-based revascularization (EBR)1. PLAN stresses a structured management approach based on Patient risk, Limb severity, and ANatomic pattern of disease, in that order of priority. In this thesis we validated different prognostic models for CLTI (part I) and tested and improved the “Global Limb Anatomic Staging System” (GLASS). Furthermore, we provide exploratory feasibility studies regarding (the alternative use of) simple, low-cost and non-invasive diagnostic tools, such as transcutaneous oxygen tension (TCpO2) measurement and nailfold capillaroscopy (NFC) in PAD (part II). We also discuss potential regenerative therapies in CLTI, especially in patients who are not eligible for conventional revascularization intervention (part III).