Peripheral Revascularization & Limb Salvage

Boala arterială periferică (BAP) afectează arterele picioarelor și poate evolua de la claudicație (durere la mers care dispare la repaus) la ischemie critică (CLTI) — situație în care circulația este atât de compromisă încât țesuturile încep să se deterioreze. Revascularizarea endovasculară deschide arterele blocate fără a fi necesară chirurgia.

• The arteries in the legs can become blocked by plaque buildup, just like the arteries in the heart
• Reduced blood flow causes pain when walking (claudication), and in severe cases, rest pain, wounds that will not heal, or tissue loss
• Acute limb ischemia is a sudden blockage — usually by a blood clot — that threatens the leg within hours
• Critical limb-threatening ischemia (CLTI) is the most advanced stage, where the limb is at risk without revascularization
• Endovascular treatment reopens blocked arteries from the inside, using catheters inserted through small punctures — often avoiding open surgery entirely

Printr-o puncție mică la nivelul arterei (de obicei la inghine sau la picior), se introduc catetere și fire ghid care ajung la locul blocajului. Artera este deschisă prin diverse tehnici, în funcție de gravitatea și localizarea leziunii.

• Imaging identifies the location and extent of the blockage — from the aorta down to the ankle arteries
• A catheter is guided to the blocked segment, and the artery is reopened using specialized wires, balloons, and stents
• In acute cases, blood clots are removed using mechanical thrombectomy (suction or fragmentation devices) or dissolved with thrombolysis (clot-dissolving medication delivered directly into the artery)
• For long or heavily calcified blockages, plaque-modification tools prepare the vessel before balloon or stent treatment
• The goal is to restore straight-line blood flow all the way to the foot, which is essential for wound healing and limb preservation

• Patients with leg pain during walking (intermittent claudication) that limits daily activity
• Patients with rest pain — pain in the foot or toes even when lying down
• Non-healing wounds or ulcers on the feet or lower legs due to poor circulation
• Critical limb-threatening ischemia (CLTI) where amputation is a real risk without treatment
• Acute limb ischemia — a sudden loss of blood flow requiring emergency intervention
• Patients with blockages at multiple levels (aortoiliac, femoropopliteal, or below-the-knee arteries)

• Aortoiliac, femoropopliteal, and infrapopliteal interventions (treatment at every level of the leg arterial tree)
• Mechanical thrombectomy (devices that physically remove blood clots from the artery)
• Catheter-directed thrombolysis (delivering clot-dissolving drugs directly to the blockage)
• Dual access — antegrade and retrograde approaches (entering the artery from above and below to tackle difficult blockages from both ends)
• Retrograde pedal and tibial techniques (accessing the artery from the foot when the standard route is blocked)
• Controlled subintimal recanalization (creating a new channel alongside a completely blocked artery segment)
• Rotational, orbital, and directional atherectomy (specialized devices that shave, sand, or cut away hard plaque)
• Drug-coated balloons — DCB (delivering medication to the vessel wall to reduce re-narrowing without a permanent stent)
• Combined plaque modification strategies before angioplasty or selective stenting