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tools and techniques

Tools & Techniques: Below the knee interventions

Clinique Pasteur, Toulouse, France

Before starting below the knee (BTK) interventions, you will consider treating patients with critical limb ischaemia (CLI) or with severe claudication. The main goal of this procedure is limb salvage. One new patient will develop CLI in every 100 patients with peripheral artery disease (diabetics have a fivefold to tenfold increased risk). CLI occurs when the essential supply of nutrients falls below the cut-off level that will sustain tissue viability: ankle systolic pressure less than 50 mmHg in non-diabetics or toe systolic pressure less than 30 mmHg in diabetics. The prognosis of CLI is very poor. Only 50% of patients with CLI will be alive with two limbs at six to 12 months after diagnosis. Twelve percent to 18% will die, 30% to 35% will have an amputation. Concerning the amputated population, only 22% will walk again and 30% will be bedbound.

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