Grasping the Nettle and Femoral Artery Stenting

When brushed against, needles on the leaves of nettles inject a noxious toxin into the skin. However, grasping the nettle firmly bends the needles away from the skin, rendering it is less painful. The expression “to grasp the nettle” is to boldly confront an issue in order to seek its resolution. The advice warns us against half measures and is timely as we gather scientific evidence to assess the value of percutanous (and surgical approaches) to treating peripheral artery disease (PAD).Article see p 495Claudication and critical limb ischemia are the 2 symptomatic manifestations of PAD. Although they share a common pathology (atherosclerosis) and a high risk of death from cardiovascular causes, their natural histories differ. Claudication impairs patient quality of life by causing painful cramps and dysfunction (eg, limping) while walking. Patients learn to avoid walking or to stop and rest when they claudicate until the discomfort eases. Over several years, symptoms may improve with collateral flow or metabolic adaption in muscle.1 However, many patients experience a progressive decline in walking and subsequent quality of life and independence. Fortunately, claudication rarely progresses to critical limb ischemia and limb loss (<2% per year).2On the other hand, critical limb ischemia is characterized by rest pain, nonhealing or poorly healing ulcers, or gangrene and more extensive tissue loss. Although this is a smaller group of symptomatic PAD, the immediate risks are to the limb, with subsequent loss of function and independence related to the level of amputation.3 Vascular bypass surgery offers a viable treatment for patients with critical limb ischemia, but traditional surgical practice limits bypass surgery to all but the most severe cases of claudication. This hesitancy is based on small, but definite perioperative risks of death and cardiovascular events,4 the long-term risks of graft …