Revascularisation dans l'artériopathie oblitérante des membres inférieurs au stade des troubles trophiques

Critical limb ischemia (CLI) represents the ultimate stage of peripheral arterial disease (PAD), associated with a high risk of cardiovascular events. In order to ensure limb salvage and wound healing, the restoration of a direct blood flow to the foot is necessary. Distal bypass surgery is the gold standard, but in recent years the revascularization strategy has been shaken by the results of endovascular treatment. The emergence of new techniques and dedicated equipment have resulted in long-term limb salvage rates equivalent to those of bypass surgery, while limiting peri-operative morbidity and mortality. Three new randomized controlled trials are currently underway in the United States and Europe (BEST-CLI, BASIL-2 and -3). The first two aim to compare endovascular treatment and bypass surgery while the latter will compare plain old balloon angioplasty, drug-coated balloon angioplasty and drug-eluting stents. These trials will provide essential information on the characteristics and prognosis of CLI and more recent evidence to guide treatment in this challenging condition.