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Infrapopliteal intervention for the treatment of the claudicant

Matthew T Menard1, Michael Belkin

  • 1Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.

Seminars in Vascular Surgery
|March 28, 2007
PubMed

Insights

Endovascular treatments for infrainguinal arterial disease are now more common for claudication due to improved safety and success. Open surgical bypass also shows excellent outcomes, prompting a reevaluation of treatment options.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Peripheral Arterial Disease

Background:

  • Infrainguinal balloon angioplasty and stenting have seen decreased risks and increased success rates.
  • Percutaneous revascularization is increasingly offered as a primary treatment for claudication.
  • Tibial occlusive disease is now frequently treated percutaneously, moving beyond traditional bypass surgery.

Purpose of the Study:

  • To examine and redefine the roles of endovascular and open surgical interventions.
  • To evaluate treatment options for patients with claudication due to infrageniculate occlusive disease.
  • To consider the changing landscape of peripheral arterial disease treatment.

Main Methods:

  • Review of recent trends in endovascular and open surgical interventions for infrainguinal arterial disease.
  • Analysis of outcomes for percutaneous revascularization and bypass grafting.
  • Evaluation of factors influencing long-term success, such as indication and conduit quality.

Main Results:

  • Improved outcomes and reduced risks have lowered the threshold for endovascular treatment of claudication.
  • Open surgical infrainguinal arterial reconstruction, particularly bypass grafting with autogenous vein, demonstrates excellent results.
  • Distal anastomosis level is less critical than operative indication and conduit quality for long-term success.

Conclusions:

  • The evolving success rates and safety profiles necessitate a reevaluation of treatment strategies for infrainguinal occlusive disease.
  • Both endovascular and open surgical approaches offer viable options for patients with claudication.
  • Further definition of the optimal role for each intervention is warranted given recent advancements.

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