How Serious is PAD?
Every 30 seconds one lower limb is amputated globally
due to PAD
Can PAD be Asymptomatic?
No symptoms
Absent lower limb pulses
ABI < 0.9
What is the morbidity of Untreated Symptomatic PAD?
> Life expectancy is 10 yrs. less compared to general population
> Symptomatic PAD is more strongly associated with cardiovascular
mortality than isolated CAD/CVA
> CLTI patients at the end of 1 year – Only 50% will be alive with
both lower limbs
Does all PAD patients need intervention?
Asymptomatic PAD & Non disabling claudication pts.
Medical management
Life style modification
Exercise therapy
Serial follow up
Disabling claudicants, Pts. with CLTI
Revascularization
Revascularization first or Amputation first ?
Dry gangrene 🡪 Revascularization first f/b
Amputation
Wet gangrene 🡪 limited debridement to let
out pus / control sepsis 🡪 Revascularization 🡪
Extensive debridement /Amputation
Evidence Based Revascularization
BASIL 1 Trial : (452 enrolled patients in 27 United Kingdom
hospitals )
For patients who survived for at least 2 years
after randomization, Bypass was associated
with a significant increase in Overall Survival
and improved Amputation Free Survival.
Evidence Based Revascularization
BEST CLI Trial : (1830 enrolled patients)
Among patients with CLTI in whom both surgical
and endovascular interventions were feasible-
Surgical revascularization with a GSV was
superior to endovascular intervention in
reducing major adverse limb events (including
above-ankle amputations) or death
Evidence Based Revascularization
BEST CLI Trial : (1830 enrolled patients)
When a great saphenous vein conduit was not
available, outcomes were similar between
surgery and endovascular therapies.
