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THE JOURNAL OF CARDIOVASCULAR SURGERY
A Journal on Cardiac, Vascular and Thoracic Surgery
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
ADVANCES IN BELOW-THE-KNEE MANAGEMENT
The Journal of Cardiovascular Surgery 2012 April;53(2):195-203
Does below-the-knee placement of drug-eluting stents improve clinical outcomes?
Katsanos K. 1, 2, Spiliopoulos S. 1, Krokidis M. 2, Karnabatidis D. 1, Siablis D. 1 ✉
1 Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, Greece
2 Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust, London, UK
Modern critical limb ischemia management algorithms endorse an “endovascular first” strategy of treatment. The advent of stents coated with anti-restenotic agents that are gradually eluted to the vessel wall has revolutionized modern endovascular therapies. Several single-center, non-randomized cohort series have provided compelling data about the short- to mid-term safety and effectiveness of drug-eluting stents in below-the-knee lesions and have fuelled further large-scale research. Three multicenter randomized trials (the YUKON-BTX, the DESTINY and the ACHILLES trials) are now available and have paved the way for level I-A evidence about infrapopliteal use of drug-eluting stents. Amassed evidence strongly supports the use of olimus-eluting metal stents for focal obstructive infrapopliteal lesions in order to inhibit restenosis, prolong vessel patency and thereby achieve sustained patient improvement, as reflected by the significantly improved Rutherford-Becker classification, reduced number of repeat procedures and a trend towards improved wound healing. The present overview outlines current evidence about clinical outcomes after below-the-knee drug-eluting stent placement compared to more traditional endovascular treatments like conventional old balloon angioplasty and bare metal stents. Available evidence is appraised in the context of clinically meaningful results and relevant unresolved issues are highlighted.