The authors comment on the article by Papoyan et al, "Retrograde Pedal Access for the Superficial Femoral Artery Recanalization In Critical Limb Ischemia."

The need for cost-effective, quality care will drive patient treatment decisions and trends. Traditionally, the transfemoral approach has offered a dependable primary access site particularly to approach lower extremity disease. Why should there be a shift toward TR peripheral interventions?

The development of BRS would have the benefit of mechanical support to prevent early vessel recoil and treat dissection similar to BMS and DES, without the permanent metallic struts that would lead to medi- um- and long-term complications such as hampered vasomotion, neo-intimal hyperplasia, and in-stent restenosis/thrombosis.

Chronic limb threatening ischemia (CLTI) remains a challenging problem, associated with both significant morbidity and mor- tality. Effective interventions, especially among those patients with complex infrapopliteal disease, have been limited. Reasons for failure are multifactorial including the nature of disease, calcification, vessel recoil, and arterial dissection.

Although the standard of care has evolved, the majority of patients with CLI undergoing primary amputation have never received a diagnostic angiogram, prohibiting the opportunity for revascularization and limb salvage.

Endovascular treatment of critical limb ischemia has been shown to be effective in preventing amputation and is oftentimes the treatment modality of first choice.

Since there was a striking paucity of high-level comparative effectiveness evidence on the optimal treatment of patients with CLTI so far, both these landmark trials were awaited with great interest. However, study outcomes are conflicting and therefore worthy of intensive review and in-depth analysis for all medical professions confronted with such patients.

Barry Katzen interviews 10 experts on CLTI who each bring their varied specialties, experiences, and opinions to help us understand the BEST-CLI trial results. Study design analysis, generalizability, and real-world application are some of the topics discussed.

The initial results of the long-awaited BEST-CLI (Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia) trial were recently published in the New England Journal of Medicine. There is a lack of prospective, randomized data to guide treatment of peripheral arterial disease, and this landmark trial is worthy of review and analysis by any practitioner treating CLTI.

Commentary on "A Novel Temporary Stent For Treatment of Infrapopliteal Arteries in Conjunction With Drug-Coated Balloon Angioplasty: The DEEPER Pilot Study" by Mustapha, et al.

Commentary on Khan A, Green DL, Santilli S, et al. Preoperative C-reactive protein levels predict readmission following elective vascular surgery. J Crit Limb Ischemia. 2022;2(2):E39-E44. 

Commentary on Jammeh ML, Suggs J, Adams GL, et al. Outcomes of orbital atherectomy in patients with critical limb threatening ischemia and diabetes. J Crit Limb Isch. 2022;2(2):E29-E37. Epub 2022 Apr 12.

Board Certified Plastic Surgeon Earl M. Johnson, Jr, comments on a study by Fujihara et al, who evaluate the current impact of plastic surgeons in managing wounds for patients with CLTI.

Dr Zeller comments on a recent JCLI meta-analysis by Al Halabi et al, who examined paclitaxel-coated drug-coated balloon (DCB) angioplasty in infrapopliteal artery lesions and found significant benefits for the use of DCB.

The recently published JCLI study by Perlander and colleagues offers an opportunity to focus on the existing gaps in our understanding of cost-effectiveness in the care for CLTI patients.

Editorial commentary on Pietzsch et al's "Cost-Effectiveness of Percutaneous Deep Vein Arterialization for Patients With No-Option Chronic Limb-Threatening Ischemia: An Exploratory Analysis Based on the PROMISE I Study."

An editorial commentary on Ghare et al's "Outcomes among patients with chronic critical limb ischemia with no revascularization option: systematic review and meta-analysis."

Editorial commentary on Mustapha et al's "Chronic total occlusions: association between characteristics and long-term outcomes in critical limb ischemia."

While CLI is becoming increasingly prevalent and deadly, CLI awareness and data are still severely lacking. The journal focus will be to harness quality data and clinical advances and to disseminate this information in a timely manner to all clinicians involved in the treatment of this complex and debilitating disease.