How paclitaxel can improve results in diabetics

Despite advances in endovascular techniques, the success of these revascularization procedures is limited by neointimal hyperplasia and subsequent restenosis or occlusion. Infrainguinal interventions have higher rates of restenosis after intervention in comparison to other vascular beds, and this is likely due to a host of anatomic, mechanical, biological and rheological factors that create a relatively hostile environment for the restoration of lower extremity perfusion through endovascular means. In addition, outcomes in the diabetic subpopulation are even worse, with a higher risk of amputation, re-interventions, and failed procedures in critical limb ischemia. Novel techniques for antiproliferative drug release into the vessel wall at the site of endovascular intervention have shown promising results in combating restenosis in the coronary arteries and data are accumulating to suggest promise in the infrainguinal arteries as well. The application of paclitaxel, delivered either through drug coated balloons or drug-eluting stents, has demonstrated benefit in enhanced durability of lower extremity endovascular procedures, and may be of particular advantage concerning diabetic limb salvage. This review presents an overview of the current literature and ongoing trials with the use of paclitaxel in diabetic lower extremity occlusive disease.