Invited commentary

As described in the article, many millions of individuals worldwide suffer from peripheral artery disease. In the United States alone, up to 100,000 peripheral artery reconstructions are performed each year. Because atherosclerosis is an inflammatory disease, it is logical to be interested in determining the role of different inflammatory markers for prognostic and potential therapy-guiding purposes.

In this particular study, the authors found that patients presenting with chronic limb ischemia (CLI) had an increase in high-sensitivity C-reactive protein (CRP), fibrinogen, and serum amyloid levels. The most striking finding was that patients with the highest levels of high-sensitivity CRP (0.5 mg/L) before surgery experienced a 60% incidence of major postoperative vascular events. It is difficult to assign importance, however, because the CLI group was not compared with an age-matched control group without CLI.

Although the study has some design flaws, it should be of interest to all who treat or monitor patients with CLI. The study was also limited because it only measured the inflammatory markers before open leg bypass.

I believe that identifying markers that predict success or failure for treating CLI patients is even more important in evaluating the evolving endovascular treatment techniques for CLI. One hopes that identifying a specific marker, or a panel of relevant markers, will contribute to predicting the success of open and endovascular procedures for CLI as well as provide some idea of long-term risk for major atherosclerotic vascular events in these complex patients. This important study presents the reader with insight into the future for monitoring and treating CLI patients.