International Panel Provides Important Guidance on Treatment of Below-the-Knee Disease in Chronic Limb-Threatening Ischemia

Innovations in Cardiovascular Medicine & Surgery | February 2024

Jun Li, MD

Mehdi Shishehbor, DO, MPH, PhD

Interventional cardiologists from University Hospitals Harrington Heart & Vascular Institute have led an international panel of colleagues who treat below-the-knee (BTK) disease in chronic limb-threatening ischemia (CLTI), issuing a needed position statement on the challenges and best practices for endovascular revascularization in these patients.

Writing in JACC: Cardiovascular Interventions, first author Jun Li, MD, an interventional cardiologist and Co-Director of the Vascular Center at UH Harrington Heart & Vascular Institute, and senior author Mehdi Shishehbor, DO, MPH, PhD, the institute’s President and Angela and James Hambrick Chair in Innovation, joined by colleagues from Australia, Italy, Singapore, Japan and Germany, provide guidance on navigating this complex disease process.

The position statement provides a comprehensive review of the essential knowledge for a BTK endovascular operator, including anatomy, recanalization techniques, challenges associated with tibial and pedal disease, as well as novel current and anticipated devices.

“Given the prevalence of BTK disease in our growing population of CLTI patients, it is vital for endovascular operators to be well versed in the techniques and treatment goals of infrapopliteal revascularization,” the panel writes. “This international treatise serves as a generalized guideline for operators to help establish and enhance their BTK skillset.”