Peripheral arterial disease is a growing global burden, with chronic limb-threatening ischemia (CLTI), its most advanced stage, associated with high morbidity, mortality, and economic costs. While randomized controlled trials are the gold standard for evaluating treatment strategies, their external validity is often limited by strict inclusion criteria that exclude complex, real-world patients with CLTI. This review underscores the need for evidence-based pathways tailored to real-world CLTI populations. 

In this discussion, CLI Global Society Publications Committee members Fadi Saab, MD, Zola N’Dandu, MD, KJ Nagarsheth, MD, and Bret Wiechmann, MD discuss the role the Committee plays in challenging the status quo and changing how patients with CLI are treated.

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.

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.

In this study and review, the authors aim to provide a focused evaluation of the influence of SES on the care, prevalence, and treatment of peripheral arterial disease and critical limb-threatening ischemia.

Drs. Saab and Nagarsheth provide commentary on the article The Tack-Optimized Balloon Angioplasty (TOBA) II Below-the-Knee Trial: 36-Month Results by Adams, et al. 

This review focuses on specific noninvasive diagnostic tools that aid in corroborating findings on history and physical examination and provide guidance for the optimal critical limb-threatening management strategy.     

A paradigm shift appears to be occurring with overwhelming evidence of transradial access (TRA) being a safe and feasible approach for peripheral interventions compared to transfemoral access (TFA). Our study explores the additional, multifactorial benefits of TRA regarding perioperative times, radiation, contrast administration, and cost-savings for patients and hospitals.

The authors completed an observational Michigan Medicare analysis to investigate the rates of peripheral vascular intervention (PVI) via endovascular approach or surgical bypass, as well as the amputation rates for potentially informative trends.

Using this retrospective study, the authors aimed to demonstrate safety and performance of the Terumo Glidesheath Slender for tibiopedal access. 

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.

Our study aims to determine whether racial and gender differences exist between Hispanic and non-Hispanic Americans regarding access and treatment for PAD care.

The objectives of this trial were to evaluate the safety and performance of the temporary stent in treating infrapopliteal arterial disease.

We performed a meta-analysis of randomized controlled trials investigating the clinical outcomes of patients undergoing percutaneous revascularization with DCB vs percutaneous transluminal angioplasty (PTA) of infrapopliteal arteries.

Despite medical advancements, PAD and CLI continue to increase globally. Treatment for PAD/CLI varies widely and patients with CTOs may be more challenging to treat, requiring specialized crossing techniques and modalities. The objective of this study was to determine the relationship between patients diagnosed with PAD/CLI, with CTOs, and subsequent long-term outcomes. 

Amputation as the initial treatment of choice remains prevalent despite advances in revascularization techniques and medical therapy. We evaluated the 7-year mortality of patients undergoing major and minor lower-extremity amputations and determined the impact of risk factors on long-term mortality.

We review here the mechanism of action of OA, supporting clinical study evidence, and corresponding economic analyses.