ABSTRACT
Chronic lower limb ischemia is common, especially in the elderly, and often associated with
troublesome symptoms of intermittent claudication. There is also an increased risk of ischemic
ulceration leading to infection and amputation. The focus of medical treatment includes
disease-modifying agents such as angiotensin-converting enzyme inhibitors and statins to
encourage stabilization and regression of atherosclerotic plaques, and to reduce the risk of
acute limb or life-threatening cardiovascular events. Revascularization is effective, but only in a
highly selected subset of patients with refractory symptoms due to discrete, proximal stenoses
that are amenable to an endovascular or bypass procedure. For the majority of patients with
chronic lower limb ischemia there are few, if any, effective treatments to achieve sustained
improvements in distal blood flow in order to provide relief from symptoms and preservation
of tissue viability.
