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Explore the Journal of Critical Limb Ischemia (JCLI), a quarterly international peer-reviewed journal and online clinical resource for those treating chronic limb threatening ischemia.

Early Online

Original Contribution

Phantom limb pain (PLP) is a common complication after major lower extremity amputations (MLEA), occurring in approximately 85% of patients. PLP significantly affects amputees’ mobility, ability to perform tasks of daily living, and overall quality of life (QoL). Previous studies have discussed surgical treatments for PLP that can improve ambulation and mobility after MLEA. The authors describe 3 patients who underwent peripheral nerve repair PNR to alleviate PLP and reported decreased pain and improved QoL.

Original Contribution

Despite a recent increase in research efforts regarding disparities in peripheral arterial disease/critical limb-threatening ischemia (PAD/CLTI), few studies have focused on minority and women participation in late-breaking clinical investigations exploring various treatments for PAD/CLTI. The authors seek to explore the representation of minority groups and women in clinical studies evaluating the usage of drug-coated balloons for treatment in PAD/CLTI.

Review

Intravascular lithotripsy (IVL) has emerged as a vessel preparation device for heavily calcified arteries during endovascular therapies.8 IVL utilizes multiple emitters mounted on a traditional angioplasty balloon catheter to deliver pulsatile acoustic pressure energy. This approach facilitates the fracture of superficial and deep calcium without compromising local soft tissues and minimizes the risk of emboli liberation.9 In this manuscript, the authors provide a comprehensive review of the role of IVL as an adjunct to endovascular revascularization in the treatment of PAD.

Videos
Videos

Dr Pliagas discusses his retrospective study, recently published in JCLI, in which he and his co-investigators sought to demonstrate safety and performance of the Terumo Glidesheath Slender for tibiopedal access. Initially, tibiopedal access was considered a very experimental technique, but over the past few years, Dr Pliagas and his colleagues have learned to routinely gain access to vessels from below, using this technique.

Current Issue

Original Contribution

Presence of calcification is a significant risk factor for treatment resistance during endovascular therapy, limiting vessel expansion and increasing rates of complication. The goal of this study is to assess the safety and efficacy of intravascular lithotripsy in the treatment of calcified peripheral arterial lesions in patients with claudication. 

Original Contribution

The pattern of surgical bypass has affected practice in the context of a multidisciplinary limb preservation program. As bypass may be required for limb preservation, such a practice would involve more frequent bypass and increased complexity of bypass performed due to the lack of an autogenous conduit and suitable target artery (“desert foot”), and patients with prior failed endovascular interventions. We investigated this change in the pattern of bypass performed in the context of our limb preservation program. 

Editorial/Commentary

Abdelghany et al, acting on behalf of the Publication Committee of the Critical Limb Ischemia Global Society, presented an insightful analysis detailing the historical progression of chronic limb-threatening ischemia (CLTI) treatment. This historical journey has been marked by numerous pioneering discoveries and breakthroughs. 

Editorial/Commentary

While strides have been made in the attention that CLTI is afforded, there continue to be challenges regarding a lack of equipoise in the management of CLTI. Addressing the significant disparities in CLTI care, especially in underserved communities, necessitates a multifaceted approach. 

Case/Review

Upper extremity CLTI attributable to infrabrachial chronic arterial occlusive disease is an infrequently encountered problem in clinical practice for which no evidence-based treatment algorithm exists. Here the authors describe their approach to a patient with right upper extremity CLTI and limited arterial runoff into the hand.

Original Contribution

The definition and treatment of CLTI have been evolving, recognizing the importance of early recognition and aggressive treatment required for those patients. In this article, the authors discuss the historical definitions of CLTI and provide an overview of how the management of patients with CLTI has developed, including surgical and endovascular interventions.

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