Overview of New Technologies for Lower Extremity Revascularization

Abstract

Abstract-Lower extremity peripheral arterial occlusive disease poses a unique challenge to traditional angioplasty-based endovascular therapies. The diffuse nature of lower extremity atherosclerotic disease, the presence of chronic total occlusions, poor distal runoff, and the presence of critical limb ischemia all have contributed to the disappointing results of balloon angioplasty for complex infrainguinal arterial disease. These challenges have spawned the development of a host of new technologies in an attempt to improve the safety and effectiveness of percutaneous revascularization for lower extremity peripheral arterial occlusive disease. This review summarizes the recent advances in available technologies, including novel angioplasty balloons; nitinol stents, stent grafts, and drug-eluting stents; excisional, laser, and rotational atherectomy devices; devices for crossing total occlusions; true-lumen reentry devices; thrombectomy catheters; and embolic protection devices.

Cryoplasty Versus Conventional Balloon Angioplasty of the Femoropopliteal Artery in Diabetic Patients: Long-Term Results from a Prospective Randomized Single-Center Controlled Trial

“…Long-term primary patency probability rates of almost 60% in both groups (59% in group CRYO vs. 55% in group COBA at 3 years) are similar to previously published data of endovascular SFA treatment [10,11,13,14,29]. We believe that these results are in line with the fact that the majority of the included patients suffered from severe intermittent claudication as well as high TASC grade and increased calcification of the treated lesions [10,11,37].…”

“…Low primary patency and increased repeat intervention rates, mainly due to vascular restenosis by means of intimal hyperplasia and negative vessel wall remodelling, has orientated modern cardiovascular research toward new alternative techniques, such as atherectomy, laser-assisted angioplasty, covered stent-grafts, brachytherapy, and cryoplasty [12][13][14]. Of note, there is no controlled evidence in the literature regarding percutaneous therapies of the femoropopliteal artery in the setting of DM apart from single-center patient cohorts [15].…”

Credentialing in interventional therapy in Europe – comparison of curricula including endovascular therapy of arterial diseases

“…Keywords: Curricula endovascular therapy, interventional training, European vascular societies cular minimal invasive therapy as a fi rst-line strategy [3,4]. In consequence, vascular medicine has become an interdisciplinary fi eld.…”

“…The prevalence of PAD increased in the past decade by 23.5 % to 202 million aff ected people globally in 2010. Over 20 % of octogenarians and more than 25 % of nonagenarians have some form of PAD [2,3]. Several novel treatment modalities and diagnostic tools were developed in the last decades, which rapidly expanded the invasive management of vascular disease and promoted endovas-This was necessary to guarantee high standards of clinical practice and patient safety.…”

“…The standard and level of training is high in all curricula and societies. However, further harmonization is needed to optimize patient care and ensure a uniform quality level across different vascular societies.Keywords: Curricula endovascular therapy, interventional training, European vascular societies cular minimal invasive therapy as a fi rst-line strategy [3,4]. In consequence, vascular medicine has become an interdisciplinary fi eld.…”