Abstract
Symptomatic peripheral arterial disease management involves medical treatment and interventional procedures. Intermittent claudication and critical limb threatened ischemia (CLTI) should be individually considered with specific outcomes and procedures. When intervention is required, an endovascular approach is usually the first-line option. Plain balloon angioplasty was previously used to dilate clinically significant femoropopliteal lesions with variable results. However, over recent years, the use of self-expanding nitinol stents has enabled treatment of long lesions, yielding significantly improved clinical results. Drug-eluting technology has also exhibited a capacity to limit in-stent restenosis and to drive target revascularization. Nevertheless, calcifications and elastic recoil of the arterial wall remain risk factors for early restenosis and failure. Therefore, vessel preparation using specific devices is required to modify vessel compliance and debulk obstructive calcification. In this short review, we provide an overview of the options for gaining lumen before stenting or dilation using drug-coated balloons.
Highlights
Symptomatic atherosclerotic disease of the lower limbs may occur as intermittent claudication or severe ischemia threatening the leg
Other risk factors for early failure, such as flow limiting dissection and elastic recoil, usually require the use of a nitinol self-expanding stent in the femoropopliteal segment. This strategy cannot be applied in the below-the-knee (BTK) vasculature due to unsatisfactory results, a meta-analysis of randomized trials indicated that use of a drug-eluting stent seems to significantly improve mid-term results in terms of patency and amputation-free survival [4]
We aimed to describe the current options for preparing a vessel in the superficial femoral artery (SFA) and BTK segment for drug-eluting technologies and for a specific self-expanding stent in the popliteal artery
Summary
Symptomatic atherosclerotic disease of the lower limbs may occur as intermittent claudication or severe ischemia threatening the leg. The VascutrakTM balloon (BD interventional, Tempe, USA) is a semi-compliant balloon with two external wires that deliver focused force along the length of the balloon It was tested in a single-center study including 29 consecutive patients with symptomatic PAD due to femoropopliteal stenosis or occlusion [12]. Minimal trauma balloon catheters, such as the Chocolate PTA Balloon, are useful for preventing flow-limiting dissection and bail-out stenting. This balloon is not a scoring balloon, as the wires running at the surface do not come in contact with the vessel wall. A single-center prospective single-arm study evaluated the use of Chocolate PTA balloon, systematically followed by DCB, in 84 patients with femoropopliteal lesions [14]. The use of a filter is required only in directional atherectomy to avoid distal embolization, which increases the cost and time of the procedure
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