Curiously, the mortality risk for patients with critical limb ischaemia (CLI) has not changed over the last few decades, despite advances in cardiovascular medicine that treat myocardial infarction and stroke, the two biggest causes of death in these patients, Sahil Parikh (New York, USA) tells BLearning Peripheral at VIVA 2019 (Vascular InterVentional Advances; 4–7 November, Las Vegas, USA).
While outlining developments in the field of drug-eluting devices, Parikh points to limus agents “coming to the fore”, but cautions that the “horizon is a long one” to see a clinically approved, or available device.
While data from randomised trials such as ongoing BEST-CLI and BASIL-3 will be used to inform decision-making on surgical or endovascular revascularisation in the future, “in the real-world, down in the trenches, where we take care of patients”, these decisions are made on an ad hoc basis and rely on what physicians know today, he asserts.
Parikh explains that the future of CLI treatment rests on a more holistic approach to the treatment of vascular disease; improved medical therapy; as well as shifting from relatively “low resolution” tools such as angiography to perfusion imaging to guide treatment before, during and after the procedure.
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