CLI: “Know the patient, know the disease and know what you can do to fix it”

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Bruce Gray (Greenville, USA) talks to Vascular News after winning the LIVE (Leader In EndoVascular Education) award at VIVA 2019 (4–7 November, Las Vegas, USA), which he says was “very humbling” and “an honour”.

Gray speaks to the challenge of applying cumulative data from randomised trials to the treatment of the individual critical limb ischaemia (CLI) patient, because patient and physician variables are “significant”. In his practice, Gray explains that he uses objective trial data as a background and then identifies what the patient’s specific needs are in the context of his own strengths as an operator, in order to arrive at a treatment decision.

He goes on to outline which CLI patients he would treat surgically and which with endovascular treatment. In this regard he says there are “a myriad of options, if you only think broadly from the start” and he outlines why he is “more likely” to use other variables such as what a patient’s goal is rather than go by the BASIL trial’s recommendations which “encouraged us to think bypass first” due to the challenge in estimating how long a CLI patient may survive.

Gray further states that “most reasons why we lose limbs is not due to circulation, but rather infection”. At the moment “we do not treat infection aggressively enough after we revascularise,” he adds.

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