Techniques in Vascular and Interventional Radiology Drug Delivery Technologies in the Superficial Femoral Artery

Abstract

Peripheral Arterial Disease (PAD) affects over 8 million people in the United States alone. While great strides have been made in reducing the burden of cardiovascular disease the prevalence of PAD is expected to rise as the global population ages. PAD characterized by narrowing of arterial blood can be asymptomatic or cause acute limb threatening claudication. It has been classically treated with bypass, but these techniques have been supplanted by endovascular therapy. Plain old Balloon Angioplasty (POBA) has been successful in helping revascularize lesions, but its effect has not been durable due to restenosis. This prompted the creation of several technologies aimed at reducing restenosis. These advances slowly improved outcomes and the durability of endovascular management. Amongst the main tools used in current endovascular practice are drug delivery devices aimed at inhibiting the inflammatory and proliferative pathways that lead to restenosis. This review will examine the current drug delivery technologies used in the SFA.

Fate of Asymptomatic Limb after Kissing Stents in Aortoiliac Occlusive Disease

“…The routine use of vascular closure devices can reduce the risk of bilateral femoral punctures necessitated by the kissing-stent approach [ 25 ]. Newer drug eluting stents theoretically deliver more effective endothelial chemotherapy to dampen neointimal hyperplasia and restenosis, although a consensus on their safety remains pending [ 26 ]. Bioabsorbable polymers may further obviate concerns regarding the deployment of a foreign body in asymptomatic vessels [ 26 ].…”

“…Newer drug eluting stents theoretically deliver more effective endothelial chemotherapy to dampen neointimal hyperplasia and restenosis, although a consensus on their safety remains pending [ 26 ]. Bioabsorbable polymers may further obviate concerns regarding the deployment of a foreign body in asymptomatic vessels [ 26 ]. The risk of vessel rupture from intervention in more complex calcified lesions can now be managed through the use of covered stents [ 27 ].…”

Twelve-Month Results From the First-in-China Prospective, Multi-Center, Randomized, Controlled Study of the FREEWAY Paclitaxel-Coated Balloon for Femoropopliteal Treatment

“…The secondary endpoints included: (1) Device success rate, which was defined as the percentage of successful balloon placement and expansion without rupture and successful withdrawal; (2) Technical success rate, which was defined as a percentage of residual stenosis of≤ 30% after target lesion treatment; (3) an ABI increased by more than 0.1 (the ABIs at discharge and the follow-up appointment compared to the ABI at baseline); (4) The primary and secondary patency rates at the 6-month follow-up appointment. Patency was defined as a peak systolic velocity of ≤ 2.4 m/s, as evaluated by duplex ultrasonography; (5) Major adverse events including all-cause death, revascularization, or major amputation; (6) Any changes in Rutherford classification from preoperative to discharge, 30 days, 6 months, and 12 months; (7) The incidence of CD-TLR at 12 months after the procedure; and (8) Device-associated severe adverse effects anytime in the process of the trial. Severe adverse events were defined as definite, probable, or possible device-associated events that required patient hospitalization, a prolonged hospitalization time, caused disability or death, affected workability, or led to congenital malformations.…”

“…Endovascular treatment has been increasingly performed in clinical practice worldwide and is recommended for more complex lesions (2)(3)(4)(5)(6). Percutaneous transluminal angioplasty (PTA) has an initial effect in restoring blood flow but is limited by vessel recoil, remodeling, and intimal hyperplasia (7). Stents have improved patency and technical success, but the patency rates of 12 months in lesions longer than 10 cm remain poor, ranging from 50 to 65% (8)(9)(10).…”