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Erschienen in: Current Cardiology Reports 4/2016

01.04.2016 | Interventional Cardiology (S Rao, Section Editor)

Endovascular Treatment of Infrapopliteal Peripheral Artery Disease

verfasst von: Ehrin J. Armstrong, Kalkidan Bishu, Stephen W. Waldo

Erschienen in: Current Cardiology Reports | Ausgabe 4/2016

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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.
Literatur
1.•
Zurück zum Zitat 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 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.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.•
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.••
Zurück zum Zitat 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 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
14.••
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.••
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.••
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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
Metadaten
Titel
Endovascular Treatment of Infrapopliteal Peripheral Artery Disease
verfasst von
Ehrin J. Armstrong
Kalkidan Bishu
Stephen W. Waldo
Publikationsdatum
01.04.2016
Verlag
Springer US
Erschienen in
Current Cardiology Reports / Ausgabe 4/2016
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-016-0708-y

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