Strategies in Infrapopliteal Intervention: Improving Outcomes in Challenging Patients

Randomized comparison of everolimus-eluting versus bare-metal stents in patients with critical limb ischemia and infrapopliteal arterial occlusive disease

“…In general, only ϳ50% of tibial lesions treated with PTA will remain patent and free from restenosis after the first year. 1,2,4,5 In many vascular beds, including coronary, carotid, renal, iliac, and infrainguinal arteries, the long-term patency of PTA can be augmented by intravascular stenting. Similarly, several clinical studies are now available that suggest that tibial stents enhance acute results by providing "rescue" in cases of dissection or acute occlusion (ie, "bailout stenting") 23,24 and may be appropriate as primary therapy in selected patients.…”

“…First described in the late 1980s, endovascular intervention has evolved to become a useful and viable option for the revascularization of patients with CLI. [1][2][3][4] Unfortunately, the major limitation of endovascular therapy remains its durability. Especially challenging is intervention in the tibial or below-the-knee (BTK) arteries for which percutaneous transluminal balloon angioplasty (PTA) rarely results in sustained patency.…”

“…1 Endovascular techniques have the decided advantages of: (1) avoiding the trauma of open operation and the need for autologous conduits; (2) avoiding incision through ischemic tissue beds; (3) options for recanalization of multiple tibial arteries; and (4) options for targeted recanalization to angiosomes specifically supplying ischemic areas. First described in the late 1980s, endovascular intervention has evolved to become a useful and viable option for the revascularization of patients with CLI.…”

“…In the current era, Ͻ50% of balloon-dilated tibial lesions remain open after 1 year. 1,2,4,5 Given the success of drug-eluting stents (DESs) in the coronary arteries, many have suggested that these devices might also be efficacious in the similarly sized tibial arteries. Indeed, several single-arm clinical studies are now available that suggest that DESs improve long-term patency after BTK endovascular intervention.…”

Durability and Efficacy of Tibial Arterial Stent Placement for Critical Limb Ischemia

“…Tibioperoneal occlusive disease is often multilevel, with extended lesions (1) in elderly, often diabetic patients (2) at high surgical risk with limited life expectancy (3). The increasing incidence of diabetes mellitus and life expectancy in developed countries has signaled an increasing burden of critical limb ischemia (CLI) on the health care system (4).…”