Illustration of blood vessels being repaired in a leg.

Shorter Healing Times: Can Planned Procedures Help With Critical Limb Ischemia?

Lena Kashyap in Health & Wellness December 2025 • 4 min read.

"Discover how a new approach to endovascular therapy is improving recovery for patients with severe leg problems."

Critical limb ischemia (CLI), the most severe form of peripheral artery disease, poses a significant threat to those affected. In CLI, reduced blood flow to the limbs leads to pain, sores that don't heal, and potentially amputation. Endovascular treatment (EVT), a minimally invasive procedure to restore blood flow, has become a standard approach. However, the journey to recovery can be long and challenging, often requiring multiple EVT procedures.

A common problem is that wounds may take a long time to heal, leading to prolonged discomfort and delayed rehabilitation. Traditionally, target lesion revascularization (TLR) – repeat interventions to open blocked arteries – are performed when wound healing stalls or when tests indicate reduced blood flow. This reactive approach may inadvertently extend the healing process.

Now, a new study investigates whether a planned, proactive approach to EVT can shorten the time to wound healing in CLI patients with tissue loss. Instead of waiting for problems to arise, regular TLR procedures are scheduled. This article explores the findings of this research, offering insights into how planned EVT could become a valuable strategy for improving outcomes for CLI patients.

Planned vs. Reactive EVT: What's the Difference?

Illustration of blood vessels being repaired in a leg.

The study, conducted at Morinomiya Hospital in Osaka, Japan, compared two approaches to EVT in patients with CLI and tissue loss. The first group received conventional EVT, where repeat procedures were performed based on signs of delayed wound healing or decreased blood flow to the affected area. The second group underwent planned EVT, where TLR procedures were scheduled every two months, regardless of immediate signs of problems.

Researchers analyzed the outcomes of 89 limbs in 76 patients who had undergone at least two EVT procedures. The conventional EVT group included 52 limbs treated between January 2013 and December 2015, while the planned EVT group consisted of 37 limbs treated between January 2016 and October 2016.

Conventional EVT (Reactive): TLR performed only when wound healing slowed or blood flow decreased.
Planned EVT (Proactive): TLR scheduled every two months, regardless of immediate symptoms.

The key question was whether the planned EVT strategy could lead to faster wound healing compared to the conventional approach. The study also looked at the overall success rate of wound healing in both groups.

The Bottom Line: Is Planned EVT a Better Approach?

The study results suggest that planned EVT can significantly shorten the time to wound healing in CLI patients with tissue loss. While the overall wound healing rates were similar between the two groups (around 70%), the planned EVT group experienced significantly faster recovery times (95 days vs. 143 days).

This finding suggests that a proactive approach to revascularization may prevent delays in wound healing and accelerate the recovery process. By scheduling regular TLR procedures, potential problems can be addressed early on, before they lead to stalled healing or further complications.

While the study has some limitations, including its retrospective nature and relatively small sample size, the results offer promising evidence for the benefits of planned EVT in CLI management. Further research is needed to confirm these findings and explore the optimal protocols for planned EVT. However, this study provides valuable insights into how a proactive approach can improve outcomes for patients with this challenging condition.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.5551/jat.45344, Alternate LINK

Title: Clinical Effects Of Planned Endovascular Therapy For Critical Limb Ischemia Patients With Tissue Loss

Subject: Biochemistry (medical)

Journal: Journal of Atherosclerosis and Thrombosis

Publisher: Japan Atherosclerosis Society

Authors: Masashi Fukunaga, Daizo Kawasaki, Machiko Nishimura, Masanao Yamagami, Reiko Fujiwara, Tsuyoshi Nakata

Published: 2019-03-01

Everything You Need To Know

What is Critical limb ischemia (CLI), and why is it so important?

Critical limb ischemia (CLI) is the most severe form of peripheral artery disease. It results from reduced blood flow to the limbs, causing pain, non-healing sores, and the risk of amputation. CLI's significance lies in its potential to cause severe complications. The implications for patients are significant, including chronic pain, reduced mobility, and a diminished quality of life. Without proper intervention, CLI can lead to limb loss.

What is Endovascular treatment (EVT), and why is it used?

Endovascular treatment (EVT) is a minimally invasive procedure designed to restore blood flow to the limbs in patients with Critical limb ischemia (CLI). It is considered a standard approach for treating CLI. EVT's importance stems from its ability to address the underlying cause of CLI by improving blood circulation. EVT offers a less invasive alternative to traditional surgery, potentially leading to quicker recovery times and reduced complications. However, the recovery journey can still be lengthy and may involve multiple procedures.

What is Target lesion revascularization (TLR), and how is it used in treatment?

Target lesion revascularization (TLR) refers to repeat interventions aimed at opening blocked arteries. Its use in the context of Endovascular treatment (EVT) is crucial. Traditionally, TLR has been performed reactively, that is, when wound healing stalls, or tests reveal reduced blood flow. The implications of TLR are significant, affecting healing times and the overall recovery process. This reactive approach, however, may inadvertently prolong the healing process, delaying a return to normal life.

What is planned Endovascular treatment (EVT), and why is it considered beneficial?

Planned Endovascular treatment (EVT) involves scheduling Target lesion revascularization (TLR) procedures proactively, typically every two months, regardless of immediate symptoms. This approach is contrasted with Conventional EVT where TLR is performed only when problems arise. The importance of planned EVT lies in its potential to shorten the time to wound healing. The implications for patients include a faster recovery, reduced discomfort, and a quicker return to daily activities. The study indicates that planned EVT can significantly improve outcomes for patients with Critical limb ischemia (CLI) and tissue loss.

What was compared in the study, and what were the implications of the findings?

The study compared Conventional Endovascular treatment (EVT) and planned EVT. Conventional EVT, or reactive EVT, involved performing Target lesion revascularization (TLR) when wound healing slowed or blood flow decreased. Planned EVT, or proactive EVT, scheduled TLR procedures every two months, irrespective of immediate symptoms. The study's findings suggest that planned EVT can significantly shorten the time to wound healing compared to conventional EVT. The implication is that this approach could become a valuable strategy for improving outcomes in patients with Critical limb ischemia (CLI) and tissue loss, leading to a better quality of life.