Recanalization of infrapopliteal occlusions eview

Crural vessel occlusive disease is a common finding in patients presenting with symptomatic chronic critical limb ischemia. This patient group has poor treatment prospects with high morbidity and mortality. Furthermore, infrapopliteal vascular disease is by its very nature technically challenging to deal with by endovascular or surgical techniques. The multilevel distribution of the disease process may be appreciated and assessed by multidetector computed tomography or magnetic resonance angiography prior to intervention, to determine the approach to treatment. Many patients are candidates for nothing more than conservative treatment. In the remaining patients, transluminal and subintimal angioplasty achieve good clinical success and limb salvage with low complications. When used in this anatomical territory these techniques require: meticulous attention to detail; a sound knowledge of suitable balloon, catheter and wire combinations; and familiarity with techniques to deal with complications.