Critical Limb Ischemia: Update for the Cardiovascular Anesthesiologist

Peripheral arterial disease (PAD) affects 230 million people worldwide, and the prevalence in those aged ≥70 years is around 15%. 1 Aday AW Matsushita K. Epidemiology of peripheral artery disease and polyvascular disease. Circ Res. 2021; 128: 1818-1832 Crossref PubMed Scopus (53) Google Scholar Although common, it still is underdiagnosed. Atherosclerosis is the most common causative factor; this affects the endothelium with lipid accumulation, plaque formation, and low-grade activation of the inflammatory cascade. This leads to multisystem involvement, with symptomatic or asymptomatic coronary (CAD) or cerebrovascular disease (CVD) artery disease in about 70% of patients. The risk of major adverse cardiac events and readmissions is higher in patients who have PAD in association with CAD or CVD. Diabetes, dyslipidemia, and tobacco use are common associations, making PAD a significant socioeconomic burden. 2 Bauersachs R Zeymer U Briere JB et al. Burden of coronary artery disease and peripheral artery disease: A literature review. Cardiovasc Ther. 2019; 20198295054 Crossref PubMed Scopus (85) Google Scholar