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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2015 December;22(4):237-48
The roles of drug-eluting technology and atherectomy in infrapopliteal occlusive disease
Yiu W. K., Conte M. S.
Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, USA
Chronic limb threatening ischemia (CLI) is often associated with occlusive disease of the infrapopliteal arteries. Percutaneous balloon angioplasty has been a standard treatment modality for infrainguinal arterial occlusive disease, but its use is limited by its relatively high restenosis rate and the frequent need of re-intervention, especially in below-the-knee (BTK) arteries. In the past decade, ongoing technology innovations, such as drug-coated balloon and drug-eluting stents have shown promising results in peripheral arterial disease. Atherectomy, a plaque debulking technology capable of disobliterating heavily calcified vessels, has also been advocated for BTK disease. However there is little in the way of high-quality comparative data to discern the relative efficacy of these interventional approaches versus each other, or versus open surgery. This review provides a current summary of evidence for these technologies in the setting of CLI and BTK occlusive disease.