Chronic Limb-Threatening Ischemia: Redefining the landscape

Joep Wijnand

Research output: ThesisDoctoral thesis 1 (Research UU / Graduation UU)

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Abstract

Peripheral arterial disease (PAD) is one of the three major clinical manifestations of
atherosclerosis, the other two being coronary artery (CAD) and cerebrovascular disease.
This thesis provides an overview of the management and prognosis of PAD and more
specifically chronic limb-threatening ischemia (CLTI). This thesis aimed to contribute to
improved definition, classification, prognostic modeling, and clinical decision making in
CLTI patients and is divided in three main topics. Part 1 and 2 focus on the validation and
improvement within two pillars of the “PLAN” concept of evidence-based revascularization
(EBR)1. PLAN stresses a structured management approach based on Patient risk, Limb
severity, and ANatomic pattern of disease, in that order of priority. In this thesis we validated
different prognostic models for CLTI (part I) and tested and improved the “Global Limb
Anatomic Staging System” (GLASS). Furthermore, we provide exploratory feasibility studies
regarding (the alternative use of) simple, low-cost and non-invasive diagnostic tools, such as
transcutaneous oxygen tension (TCpO2) measurement and nailfold capillaroscopy (NFC) in
PAD (part II). We also discuss potential regenerative therapies in CLTI, especially in patients
who are not eligible for conventional revascularization intervention (part III).
Original languageEnglish
Awarding Institution
  • University Medical Center (UMC) Utrecht
Supervisors/Advisors
  • Verhaar, Marianne, Primary supervisor
  • de Borst, Gert Jan, Supervisor
  • Teraa, Martin, Co-supervisor
Award date25 Mar 2024
Publisher
Print ISBNs978-94-6496-058-7
DOIs
Publication statusPublished - 25 Mar 2024

Keywords

  • CLTI
  • AFS
  • PAD
  • GLASS
  • CLI

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