Endovascular Recanalization for Infrapopliteal Artery Disease in Chronic Limb-Threatening Ischemia: A Practical Review

Patients with chronic limb-threatening ischemia (CLTI) are typically older adults with multiple comorbidities, placing them at high risk for major amputation and mortality. As CLTI frequently occurs in patients with diabetes or end-stage renal disease, it often presents as stenosis or occlusion with calcification of the infrapopliteal (IP) arteries. Endovascular therapy (EVT) has become widely adopted as a first-line treatment and an alternative to surgical bypass in the management of CLTI, owing to its high technical success rate and favorable limb salvage rate. However, IP lesions in patients with CLTI are often long, diffuse, heavily calcified, and totally occluded and may extend below the ankle, making it challenging to achieve optimal procedural success and long-term durability. This review aimed to explore current treatment strategies for CLTI associated with IP artery disease and discuss practical techniques for achieving successful EVT.