Endovascular Interventions in Iliac and Infrainguinal Occlusive Artery Disease

Abstract

Percutaneous endovascular procedures are increasingly applied to treat symptomatic peripheral occlusive artery disease. While the primary technical success and recanalization rates in iliac and infrainguinal interventions are high, differences in the long-term patency rates exist with respect to the anatomic localization, separating the iliac, femoropopliteal, and infrapopliteal arterial regions. In iliac arteries, even complex lesions can be recanalized with good long-term patency rates, especially when using self-expanding nitinol stents. In the infrainguinal arteries the method of choice is still under debate (e.g., balloon angioplasty vs stent implantation). A high restenosis rate represents one of the major limitations in femoropopliteal and infrapopliteal interventions. Therefore, additional methods and treatment strategies for peripheral interventions with the potential for future applications are under investigation and will be discussed such as drug-eluting stents, brachytherapy, subintimal angioplasty, laser angioplasty, atherectomy/thrombectomy, cutting balloon, polytetrafluoroethylene (PTFE)-covered stent grafts, biodegradable stents, and cryoplasty. The increasing amount of data on successful peripheral interventions supports the necessity to adapt and reevaluate the current consensus guidelines that were put together in 2000.

Sirolimus-Eluting Versus Bare Stents for Bailout After Suboptimal Infrapopliteal Angioplasty for Critical Limb Ischemia: 6-Month Angiographic Results From a Nonrandomized Prospective Single-Center Study

“…23,24 Proposed strategies to augment angioplasty technical success rates and inhibit late restenosis include cutting balloons; subintimal recanalization techniques; and bare, drug-eluting, or even magnesium alloy bioabsorbable stents. 13,[25][26][27][28] Although stenting of the tibial arteries is usually reserved as a bailout procedure and published data are limited, 11,12,28 experience with the utilization of stents in the infrapopliteal territory is being accumulated. 6,29 In our study, initial technical success was high in both arms of the study, with the exception of one MAE; there was no case of distal macroembolization, and the hospitalization period was short.…”

Diabetic foot ulceration and amputation

“…Macrovascular disease is morphologically the same in diabetics and non-diabetics differing only in location with the anterior and posterior tibial and peroneal arteries of the calf being most affected in persons with DM. Surgical options are dependent on whether the vascular disease is supra-inguinal (aorto-iliac) or infra-inguinal (femoro-popliteal-crural) or both ( (Ruef et al, 2004). Angioplasty, endoarterectomy, grafting, and by-pass are some available surgical interventions.…”

Detection and Treatment of Vulnerable Plaques and Vulnerable Patients

“…Cryoenergy is currently being studied for the treatment of peripheral arterial disease. 225 Although heating and sonotherapy have also been considered as possible methods to treat vulnerable plaque, 70 little supporting evidence is available. 226 …”