Critical ischemia of the lower extremities: modern aspects of diagnosis and treatment

Critical limb ischemia (CLI) is a manifestation of peripheral artery disease (PDA) in patients with typical chronic ischemic resting pain or ischemic skin damage in the form of ulcers or gangrene, objectively confirmed by occlusive artery diseases. CLI has a high risk of painful (at and above the ankle) amputations, cardiovascular events and death. Ultrasound Doppler, ultrasound duplex scanning, non-invasive (MRA and CTA) angiography help determine the appropriateness and tactics for arterial revascularization. Reconstructive and reconstructive operations in the form of open and hybrid operations are the most successful when applying good quality autovena with a diameter of 3.0-3.5 mm. Balloon angioplasty and stenting form the basis of endovascular methods, drug-coated stents and drug-coated balloons provide a low frequency of repeated revascularizations. In patients with distal lesions of the arteries, if it is impossible to conduct direct revascularization, indirect methods of revascularization are used. Drug treatment before vascular surgery, perioperative period and long-term after surgery is aimed at risk factors for atherosclerosis and thromboangiitis obliteration, promotes wound healing, reduces the frequency of cardiovascular events and death. The state of the gene and cell therapy for the treatment in subset of patients with CLI not eligible for revascularization is reported