scholarly journals Current status of infrapopliteal artery stenting in patients with critical limb ischemia

2008 ◽  
Vol 7 (3) ◽  
pp. 248-255 ◽  
Author(s):  
Marc Bosiers ◽  
Koen Deloose ◽  
Rodrigo Moreialvar ◽  
Jurgen Verbist ◽  
Patrick Peeters
Keyword(s):  
Limb Ischemia ◽  
Transluminal Angioplasty ◽  
Current Status ◽  
Infrapopliteal Artery ◽  
Below The Knee ◽  
Suboptimal Outcome ◽  
Drug Eluting ◽  
Late Luminal Loss ◽  
The Given ◽  
Percutaneous Transluminal

Due to the fear that early thrombosis and late luminal loss resulting from intimal hyperplasia might impede sustained patency of small-caliber arteries, such as those of the infrapopliteal bed, stent implantation in below-knee vessels remains controversial and is generally reserved for cases with a suboptimal outcome after percutaneous transluminal angioplasty (i.e. > 50% residual stenosis, flow-limiting dissection). Although evidence starts to build, favoring the use of stenting in the tibial area, results of well-conducted randomized controlled trials have to be awaited to change this strategy. Because of diameter similarities with coronary arteries, the first stents applied in the infrapopliteal vessels were all coronary devices. Once the feasibility of the stenting approach with these coronary products was shown, device manufacturers started to develop a dedicated infrapopliteal product range. To date, a broad spectrum of stent types has been used and investigated for the given indication. This article overviews the available literature and results of different balloon-expandable (bare metal, passive coated, drug eluting), self-expanding and absorbable stent types available for below-the-knee application and gives recommendations for future device technology advancements.

Abstract 16656: Drug Eluting Balloon Versus Percutaneous Transluminal Angioplasty Below the Knee Intervention for Critical Limb Ischemia: A Meta-analysis of Randomized Controlled Trials

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Muhammad Khalid ◽  
Mahmoud El Iskandarani ◽  
Vijay Ramu ◽  
Michael Donovan ◽  
Terry Forrest ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Meta Analysis ◽  
Limb Ischemia ◽  
Target Lesion ◽  
Major Amputation ◽  
Transluminal Angioplasty ◽  
Below The Knee ◽  
All Cause Mortality ◽  
Drug Eluting ◽  
Drug Eluting Balloon

Introduction: Studies have shown decrease rates of restenosis and target lesion revascularization (TLR) with drug eluting balloon (DEB) in diabetic patients with critical limb ischemia (CLI). Hypothesis: The aim of this meta-analysis to compare the efficacy of DEB versus Percutaneous transluminal angioplasty (PTA) below the knee peripheral intervention. Methods: Electronic databases including MEDLINE, ClinicalTrials.gov and the Cochrane Library were searched for all randomized controlled trials (RCTs) published until April 2020 comparing outcomes of DEB vs PTA in patients with CLI below the knee. End points were major amputation, major adverse events (MAEs), all-cause mortality, target lesion revascularization (TLR), myocardial infarction, and cerebrovascular accidents (CVA). The risk ratio (RR) with 95% confidence interval (CI) were computed and p <0.05 was considered as a level of significance. Results: A total of 4 RCTs (n=655) were included in the final analysis. There were no differences of major amputation (RR: 1.30; CI: 0.68-2.46; p=0.43), MAEs (RR: 0.86; CI: 0.60-1.23; p=0.41), all-cause mortality (RR: 0.91; CI: 0.69-1.19; p=0.48), TLR (RR: 0.65; CI: 0.30-1.44; p=0.29), MI (RR: 1.71; CI: 0.57-5.14; p=0.34) and CVA (RR: 0.66; CI: 0.19-2.26; p=0.50) between the 2 groups [Figure 1]. Conclusions: There were no significant differences of major amputation and TLR for DEB versus PTA . Major adverse cardiac, cerebrovascular events and all-cause mortality were not statistically different for drug coated balloon versus PTA in the management of below knee critical limb ischemia. Further studies needed to confirm these findings.

scholarly journals Preventing Leg Amputations in Critical Limb Ischemia With Below-the-Knee Drug-Eluting Stents

2010 ◽  
Vol 55 (15) ◽  
pp. 1580-1589 ◽  
Author(s):  
Andrew J. Feiring ◽  
Mari Krahn ◽  
Lori Nelson ◽  
Amy Wesolowski ◽  
Daniel Eastwood ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Drug Eluting Stents ◽  
Below The Knee ◽  
Drug Eluting

Evaluation of foot hypoperfusion and estimation of percutaneous transluminal angioplasty outcome in patients with critical limb ischemia using intravoxel incoherent motion microperfusion MRI

2021 ◽  
pp. 20210215
Author(s):  
Nikolaos Galanakis ◽  
Thomas G Maris ◽  
Georgios Kalaitzakis ◽  
Nikolaos Kontopodis ◽  
Nikolas Matthaiou ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Percutaneous Transluminal Angioplasty ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Transluminal Angioplasty ◽  
Lower Limbs ◽  
Intravoxel Incoherent Motion ◽  
Healthy Individuals ◽  
Imaging Protocol ◽  
Percutaneous Transluminal

Objectives: To emerge hypoperfusion of lower limbs in patients with critical limb ischemia (CLI) using Intravoxel Incoherent Motion microperfusion magnetic resonance imaging (IVIM-MRI). Moreover to examine the ability of IVIM-MRI to differentiate patients with severe peripheral arterial disease (PAD) from normal subjects and evaluate the percutaneous transluminal angioplasty (PTA) results in patients with CLI. Methods: Eight patients who presented with CLI and six healthy volunteers were examined. The patients underwent IVIM-MRI of lower extremity before and following PTA. The imaging protocol included sagittal diffusion-weighted (DW) sequences. DW images were analyzed and color parametric maps of the micro-circulation of blood inside the capillary network (D*) were constructed. The studies were evaluated by two observers to define interobserver reproducibility. Results: Technical success was achieved in all patients (8/8). The mean ankle-brachial index increased from 0.35 ± 0.2 to 0.76 ± 0.25 (p < 0.05). Successful revascularization improved IVIM microperfusion. Mean D* increased from 279.88 ± 13.47 10−5 mm2/s to 331.51 ± 31 10−5 mm2/s, following PTA, p < 0.05. Moreover, PAD patients presented lower D* values as compared to healthy individuals (279.88 ± 13.47 10−5 mm2/s vs 332.47 ± 22.95 10−5 mm2/s, p < 0.05, respectively). Good interobserver agreement was obtained with an ICC = 0.84 (95% CI 0.64–0.93). Conclusions: IVIM-MRI can detect differences in microperfusion between patients with PAD and healthy individuals. Moreover, significant restitution of IVIM microperfusion is found following successful PTA. Advances in knowledge: IVIM-MRI is a safe, reproducible and effective modality for evaluation of lower limb hypoperfusion in patients with PAD. It seems also to be a helpful tool to detect changes of tissue perfusion in patients with CLI following revascularization.

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