Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Current Cardiology Reports
Published in: Current Cardiology Reports 4/2016

01-04-2016 | Interventional Cardiology (S Rao, Section Editor)

Endovascular Treatment of Infrapopliteal Peripheral Artery Disease

Authors: Ehrin J. Armstrong, Kalkidan Bishu, Stephen W. Waldo

Published in: Current Cardiology Reports | Issue 4/2016

Login to get access

Abstract

Endovascular treatment of infrapopliteal disease is focused on the treatment of patients with rest pain or critical limb ischemia (CLI) due to severe atherosclerotic disease. While the evidence base surrounding the comparative effectiveness of endovascular intervention vs. surgery is lacking, many operators have adopted an “endovascular first” approach to the treatment of infrapopliteal atherosclerotic disease due to the lower morbidity of these procedures. This manuscript reviews current data on the endovascular treatment of CLI, including a comparison of endovascular and surgical approaches, current indications for and outcomes with balloon angioplasty of infrapopliteal PAD, angiosome-guided revascularization, and emerging technologies to improve long-term vessel patency after endovascular intervention.
Literature
1.•
Nehler MR, Duval S, Diao L, et al. Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population. J Vasc Surg. 2014;60:686–95. This article provides up-to-date estimates of critical limb ischemia prevalence among insured patients.CrossRefPubMed
2.
Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl):1–67.
3.
Abu Dabrh AM, Steffen MW, Undavalli C, et al. The natural history of untreated severe or critical limb ischemia. J Vasc Surg. 2015;S0741-5214.
4.
Bisdas T, Borowski M, Torsello G, et al. Current practice of first-line strategies in patients with critical limb ischemia. J Vasc Surg. 2015;62:965–73.CrossRefPubMed
5.
Singh GD, Armstrong EJ, Yeo KK, et al. Endovascular recanalization of infrapopliteal occlusions in patients with critical limb ischemia. J Vasc Surg. 2014;59:1300–7.CrossRefPubMedPubMedCentral
6.
Abu Dabrh AM, Steffen MW, Asi N, et al. Bypass surgery versus endovascular interventions in severe or critical limb ischemia. J Vasc Surg. 2015;S0741-5214.
7.
Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366:1925–34.CrossRefPubMed
8.
Bradbury A, Adam D, Bell J, et al. BASIL trial Participants. Bypass Versus Angioplasty in Severe Ischemia of the Leg (BASIL) trial: analysis of amputation free and overall survival by treatment received. J Vasc Surg. 2010;51:18S–31S.CrossRefPubMed
9.•
Soga Y, Iida O, Takahara M, et al. Two-year life expectancy in patients with critical limb ischemia. J Am Coll Cardiol Intv. 2014;7:1444–9. This article identifies risk factors for 2-year mortality in CLI, which may help with risk stratification for treatment strategies. CrossRef
10.
Shiraki T, Iida O, Takahara M, et al. Predictive scoring model of mortality after surgical or endovascular revascularization in patients with critical limb ischemia. J Vasc Surg. 2014;60:383–9.CrossRefPubMed
11.
Shiraki T, Iida O, Takahara M, et al. Predictors of 2-year mortality and risk stratification after surgical or endovascular revascularization of infrainguinal artery disease in hemodialysis patients with critical limb ischemia. J Endovasc Ther. 2015;22:719–24.CrossRefPubMed
12.••
Farber A, Rosenfield K, Menard M. The BEST-CLI Trial: a multidisciplinary effort to assess which therapy is best for patients with critical limb ischemia. Tech Vasc Interv Radiol. 2014;17:221–4. This paper provides an overview of the BEST-CLI trial, which will be the largest ever trial of patients with critical limb ischemia. CrossRefPubMed
13.
14.••
Gray B, Diaz-Sandoval L, Dieter R, Jaff M, White C. Peripheral Vascular Disease Committee for the Society for Cardiovascular Angiography and Interventions. SCAI expert consensus statement for infrapopliteal arterial intervention appropriate use. Catheter Cardiovasc Interv 2014;84. This first attempts at appropriate use criteria for infrapopliteal endovascular intervention provides practical guidance on the indications for below-the-knee endovascular intervention.
15.
Conte MS, Bandyk DF, Clowes AW, Moneta GL, Seely L, Lorenz TJ, et al. Results of PREVENT III: a multicenter, randomized trial of edifoligide for the prevention of vein graft failure in lower extremity bypass surgery. J Vasc Surg. 2006;43:742–51.CrossRefPubMed
16.
Brass EP, Anthony R, Dormandy J, Hiatt WR, Jiao J, Nakanishi A, et al. Parenteral therapy with lipo-ecraprost, a lipid-based formulation of a PGE1 analog, does not alter six-month outcomes in patients with critical leg ischemia. J Vasc Surg. 2006;43:752–9.CrossRefPubMed
17.
Conte MS, Geraghty PJ, Bradbury AW, et al. Suggested objective performance goals and clinical trial design for evaluating catheter-based treatment of critical limb ischemia. J Vasc Surg. 2009;50:1462–73.CrossRefPubMed
18.
Iida O, Nakamura M, Yamauchi Y, et al. Endovascular treatment for infrainguinal vessels in patients with critical limb ischemia: the OLIVE registry, a prospective, multicenter study in Japan with 12-month follow-up. Circ Cardiovasc Interv. 2013;6:68–76.CrossRefPubMed
19.••
Iida O, Nakamura M, Yamauchi Y, et al. Three-year outcomes of the OLIVE registry, a prospective multicenter study of patients with critical limb ischemia. J Am Coll Cardiol Intv. 2015;8:1493–502. This paper provides updated 3-year outcomes of critical limb ischemia in a large multicenter population of patients. CrossRef
20.
Patel MR, Conte MS, Cutlip DE, et al. Evaluation and treatment of patients with lower extremity peripheral artery disease: consensus definitions from the Peripheral Academic Research Consortium (PARC). J Am Coll Cardiol. 2015;65:931–41.CrossRefPubMed
21.
Iida O, Soga Y, Hirano K, et al. Long-term results of direct and indirect endovascular revascularization based on the angiosome concept patients with critical limb ischemia presenting with isolated below-the-knee lesions. J Vasc Surg. 2012;55:363–70.CrossRefPubMed
22.
Iida O, Nanto S, Uematsu M, et al. Importance of the angiosome concept for endovascular therapy in patients with critical limb ischemia. Catheter Cardiovasc Interv. 2010;75:830–6.PubMed
23.
Kabra A, Suresh KR, Vivekanand V, et al. Outcome of angiosome and non-angiosome targeted revascularization in critical limb ischemia. J Vasc Surg. 2013;57:44–9.CrossRefPubMed
24.
Kret MR, Cheng D, Azarbal AF, et al. Utility of direct angiosome revascularization and runoff scores in predicting outcomes in patients undergoing revascularization for critical limb ischemia. J Vasc Surg. 2014;59:121–8.CrossRefPubMed
25.
Bosanquet DC, Glasbey JC, Williams IM, et al. Systematic review and meta-analysis or direct versus indirect angiosomal revascularization of infrapopliteal arteries. Eur J Vasc Endovasc Surg. 2014;48:88–97.CrossRefPubMed
26.
Iida O, Takahara M, Soga Y, et al. Worse limb prognosis for indirect versus direct endovascular revascularization only in patients with critical limb ischemia complicated with wound infection and diabetes mellitus. Eur J Vasc Endovasc Surg. 2013;46:575–82.CrossRefPubMed
27.
Iida O, Takahara M, Soga Y, et al. Impact of angiosome-oriented revascularization on clinical outcomes in critical limb ischemia patients without concurrent wound infection and diabetes. J Endovasc Ther. 2014;21:607–15.CrossRefPubMed
28.
Feiring AJ, Krahn M, Nelson L, et al. Preventing leg amputations in critical limb ischemia with below-the-knee drug-eluting stents. J Am Coll Cardiol. 2012;55:1580–9.CrossRef
29.
Scheinert D, Katsanos K, Zeller T, et al. A prospective randomized multicenter comparison of balloon angioplasty and infrapopliteal stenting with the sirolimus-eluting stent in ischemic peripheral arterial disease. J Am Coll Cardiol. 2012;60:2290–5.CrossRefPubMed
30.
Bosiers M, Scheinert D, Peeters P, et al. Randomized comparison of everolimus-eluting versus bare-metal stents in patients with critical limb ischemia and infrapopliteal arterial occlusive disease. J Vasc Surg. 2012;55:390–9.CrossRefPubMed
31.
Rastan A, Brechtel K, Krankenberg H, et al. Sirolimus-eluting stents for treatment of infrapopliteal arteries reduce clinical event rate compared to bare-metal stents. J Am Coll Cardiol. 2012;60:587–91.CrossRefPubMed
32.
Falkowski A, Poncyljusz W, Wilk G, et al. The evaluation of primary stenting of sirolimus-eluting versus bare-metal stents in the treatment of atherosclerotic lesions of crural arteries. Eur Radiol. 2009;19:966–74.CrossRefPubMed
33.
Siablis D, Kitrou PM, Spiliopoulos S, et al. Paclitaxel-coated balloon angioplasty versus drug-eluting stenting for the treatment of infrapopliteal long-segment arterial occlusive disease: the IDEAS randomized controlled trial. J Am Coll Cardiol Intv. 2014;7:1048–56.CrossRef
34.
Fusaro M, Cassese S, Ndrepepa G, et al. Drug eluting stents for revascularization of infrapopliteal arteries. J Am Coll Cardiol Intv. 2013;6:1284–93.CrossRef
35.
Karnabatidis D, Katsanos K, Spiliopoulos S, et al. Incidence, anatomical location, and clinical significance of compressions and fractures in infrapopliteal balloon-expandable metal stents. J Endovasc Ther. 2009;16:15–22.CrossRefPubMed
36.
Schmidt A, Piorkowski M, Werner M, et al. First experience with drug-eluting balloons in infrapopliteal arteries. J Am Coll Cardiol. 2011;58:1105–9.CrossRefPubMed
37.
Liistro F, Porto I, Angioli P, et al. Drug-Eluting Balloon in Peripheral Intervention for Below the Knee Angioplasty Evaluation (DEBATE-BTK): a randomized trial in diabetic patients with critical limb ischemia. Circulation. 2013;128:615–21.CrossRefPubMed
38.••
Zeller T, Baumgartner I, Scheinert D, IN.PACT DEEP Trial Investigators, et al. Drug-eluting balloon versus standard balloon angioplasty for infrapopliteal revascularization in critical limb ischemia: 12-month results from the IN.PACT DEEP randomized trial. J Am Coll Cardiol. 2014;64:1568–76. This large, randomized trial of drug-coated balloon angioplasty in patients with critical limb ischemia questions the utility of this therapeutic modality for treatment of infrapopliteal peripheral artery disease. CrossRefPubMed
39.
Rocha Singh KJ, Jaff M, Joye J, et al. Major adverse limb events and wound healing following infrapopliteal artery stent implantation in patients with critical limb ischemia: the XCELL trial. Catheter Cardiovasc Interv. 2012;80:1042–51.CrossRefPubMed
40.
Schulte KL, Pilger E, Schellong S, et al. Primary self-expanding nitinol stenting vs. balloon angioplasty with optional bailout stenting for the treatment of infrapopliteal artery disease in patients with severe intermittent claudication or critical limb ischemia. J Endovasc Ther. 2015;22:690–7.CrossRefPubMed
41.
Bosiers M, Peeters P, D’Archambeau O, et al. AMS INSIGHT—absorbable metal stent implantation for treatment of below-the-knee critical limb ischemia: 6-month analysis. Cardiovasc Intervent Radiol. 2009;32:424–35.CrossRefPubMedPubMedCentral
42.
Owens CD, Gasper WJ, Walker JP, et al. Safety and feasibility of adjunctive dexamethasone infusion into the adventitia of the femoropopliteal artery following endovascular intervention. J Vasc Surg. 2014;59:1016–24.CrossRefPubMedPubMedCentral
Metadata
Title
Endovascular Treatment of Infrapopliteal Peripheral Artery Disease
Authors
Ehrin J. Armstrong
Kalkidan Bishu
Stephen W. Waldo
Publication date
01-04-2016
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 4/2016
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-016-0708-y

Other articles of this Issue 4/2016

Current Cardiology Reports 4/2016 Go to the issue

Congenital Heart Disease (RA Krasuski, Section Editor)

State of the Art of Combined Heart-Lung Transplantation for Advanced Cardiac and Pulmonary Dysfunction

Interventional Cardiology (S Rao, Section Editor)

Percutaneous Coronary Intervention: Relationship Between Procedural Volume and Outcomes

Cardiac PET, CT, and MRI (SE Petersen and F Pugliese, Section Editors)

Cardiac CT Imaging of Plaque Vulnerability: Hype or Hope?

Ischemic Heart Disease (D Mukherjee, Section Editor)

Coronary Sinus Stent: Could It Help in Refractory Chronic Stable Angina?

Congenital Heart Disease (RA Krasuski, Section Editor)

Impact of Right-Sided-Catheter-Based Valve Implantation on Decision-Making in Congenital Heart Disease

Ischemic Heart Disease (D Mukherjee, Section Editor)

Clinical Application of Fractional Flow Reserve–Guided Percutaneous Coronary Intervention for Stable Coronary Artery Disease