Abstract
The goal of infrapopliteal endovascular therapy is the re-establishment of straight-line flow to the foot with adequate perfusion of tissue. This treatment should be the first method in properly selected patients to relieve ischaemic rest pain, heal ulcers and prevent limb loss, improving quality of life. Percutaneous angioplasty (PTA) continues to be the cornerstone of infrapopliteal therapy. Metal stents are reserved for suboptimal PTA. Although data are accumulating that may eventually guide the use of alternative devices such as lasers, excisional and rotational atherectomy, drug-eluting stents or drug-coated balloons, we currently lack adequate evidence demonstrating improved outcomes. Endovascular therapy has expanded to include patients with severe co-morbidities such as renal failure and complex occlusive disease. Despite advances in below-the-knee (BTK) angioplasty balloons and a focus on angioplasty technique, current PTA results demonstrate one-year restenosis rates up to 80 %, depending on lesion complexity. Drug-coated balloons have demonstrated superior patency in the superficial femoral artery and it is yet to be determined if this technology can achieve improved patency and the clinical outcomes in the infrapopliteal region.
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