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Endovascular Treatment of Infrapopliteal Peripheral Artery Disease

Ehrin J Armstrong1, Kalkidan Bishu2, Stephen W Waldo2

  • 1VA Eastern Colorado Healthcare System and Division of Cardiology, University of Colorado, Denver, CO, USA. ehrin.armstrong@gmail.com.

Current Cardiology Reports
|February 26, 2016
PubMed

Insights

Endovascular treatment offers a lower-morbidity option for critical limb ischemia (CLI) caused by infrapopliteal arterial disease. This review covers current data, comparing endovascular and surgical methods, and discusses new technologies for improved outcomes.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Peripheral Artery Disease

Background:

  • Critical limb ischemia (CLI) and rest pain are often caused by severe infrapopliteal atherosclerotic disease.
  • An "endovascular first" approach is increasingly adopted for infrapopliteal disease due to lower procedural morbidity.
  • Comparative effectiveness data between endovascular intervention and surgery remain limited.

Purpose of the Study:

  • To review current data on endovascular treatment for CLI.
  • To compare endovascular and surgical revascularization strategies for infrapopliteal disease.
  • To discuss emerging technologies for enhancing long-term patency after endovascular interventions.

Main Methods:

  • Review of current literature on endovascular treatment of infrapopliteal atherosclerotic disease.
  • Analysis of comparative effectiveness data for endovascular versus surgical approaches.
  • Evaluation of outcomes associated with balloon angioplasty, angiosome-guided revascularization, and novel technologies.

Main Results:

  • Endovascular approaches are favored for CLI due to lower morbidity, despite limited comparative data.
  • Balloon angioplasty is a key endovascular treatment for infrapopliteal peripheral artery disease (PAD).
  • Angiosome-guided revascularization and new technologies show promise for improving long-term outcomes.

Conclusions:

  • Endovascular therapy is a viable and often preferred strategy for CLI management.
  • Further research is needed to establish definitive comparative effectiveness between endovascular and surgical treatments.
  • Advancements in technology are crucial for improving the durability of endovascular interventions in infrapopliteal PAD.

Keywords:
Balloon angioplastyCritical limb ischemiaEndovascular interventionPeripheral artery disease

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