Endovascular Versus Surgical Management of Chronic Limb-Threatening Ischemia

Purpose of reviewThe purpose of this review is to provide an updated summary of current evidence regarding management strategies for critical limb-threatening ischemia (CLTI).Recent findingsTraditionally, arterial revascularization is achieved with bypass surgery. Catheter-based technologies have afforded a wide array of endovascular therapies amenable for treating CLTI. Randomized controlled studies, including the BASIL and the BEST-CLI trials, have demonstrated that patients with favorable anatomy will most likely benefit from a bypass-first revascularizations strategy, provided adequate life expectancy and controlled perioperative risks, whereas higher risk patients with limited life expectancy should be considered for an endovascular-first approach.SummaryUntil more robust data becomes available, the choice of revascularization strategy depends on the providers' expertise as well as on the patients' preferences, expected perioperative risk, and anticipated long-term survival. The management decision should rely heavily on an interdisciplinary approach within an institution.