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Balloon Angioplasty of Infrapopliteal Arteries: A Systematic Review and Proposed Algorithm for Optimal Endovascular

Stefanos Giannopoulos1, Ramon L Varcoe2, Michael Lichtenberg3

  • 1Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA.

Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists
|June 24, 2020
PubMed

Insights

Balloon angioplasty is a common treatment for chronic limb-threatening ischemia (CLTI) in infrapopliteal arteries. Optimizing this procedure requires careful technique and new devices to improve long-term outcomes.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Endovascular Interventions

Background:

  • Chronic limb-threatening ischemia (CLTI) often involves atherosclerotic disease in the infrapopliteal arteries.
  • Lesions in these arteries result from medial calcification and intimal atheromatous plaque.
  • Balloon angioplasty is the primary endovascular treatment despite a lack of specialized devices.

Purpose of the Study:

  • To review the current understanding and treatment of infrapopliteal arterial lesions.
  • To outline an optimal balloon angioplasty technique for CLTI.
  • To identify areas for future device development in endovascular therapy.

Main Methods:

  • Systematic review of endovascular revascularization for infrapopliteal atherosclerotic disease.
  • Analysis of balloon angioplasty mechanisms, including adventitial stretching, medial necrosis, and dissection.
  • Development of a treatment algorithm based on vessel assessment and procedural techniques.

Main Results:

  • Balloon angioplasty mechanisms can lead to dissection, recoil, and early restenosis.
  • Optimal angioplasty requires careful assessment of calcification, vessel sizing, and prolonged balloon inflation.
  • A treatment algorithm is proposed to guide optimal balloon angioplasty.

Conclusions:

  • Further development of specialized devices is crucial for treating infrapopliteal lesions.
  • Devices for preventing recoil, managing dissections, and inhibiting neointimal hyperplasia are needed.
  • Improved understanding and new technologies will enhance endovascular intervention durability and limb salvage in CLTI patients.

Keywords:
atherectomyballoon angioplastycalcificationchronic limb-threatening ischemiacritical limb ischemiadissectiondrug-coated balloondrug-eluting stentendovascular revascularizationinfrapopliteal diseaserecoilresidual stenosisrestenosisstent

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