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Percutaneous Management of Lower Extremity Arterial Disease: Patient Selection, Techniques, and Technologies

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Abstract

Peripheral arterial disease (PAD) involving lower extremity arterial vessels is a common manifestation of generalized atherosclerosis that affects a large proportion of the adult population worldwide. Though intermittent claudication and critical limb ischemia are recognized presentations of lower extremity PAD, it is important to point out that a large number of patients present with subclinical forms of PAD and are asymptomatic. In fact, the presence of symptomatic expression of lower extremity PAD defines a small subset of the total population with the disease; it is estimated that out of nearly eight million men and women with PAD in the United States, 20–50 % are asymptomatic.

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References

  1. Criqui MH, Denenberg JO, Langer RD, Fronek A. The epidemiology of peripheral arterial disease: importance of identifying the population at risk. Vasc Med. 1997;2:221–6.

    PubMed  CAS  Google Scholar 

  2. McDermott MM, Fried L, Simonsick E, Ling S, Guralnik JM. Asymptomatic peripheral arterial disease is independently associated with impaired lower extremity functioning: the women’s health and aging study. Circulation. 2000;101:1007–12.

    Article  PubMed  CAS  Google Scholar 

  3. Hallett JW, Rooke TW, Koch M. The Mayo Vascular Center experience. Cardiovasc Surg. 1998;6:333–6.

    Article  PubMed  CAS  Google Scholar 

  4. O'Brien G, Martin Z, Haider N, et al. An analysis of vascular surgery in elderly patients to determine whether age affects treatment strategy. Ir J Med Sci. 2012;181(1):73–6.

    Article  PubMed  Google Scholar 

  5. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease. Int Angiol. 2007;26:81–157.

    PubMed  CAS  Google Scholar 

  6. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006;47: 1239–312.

    Article  PubMed  Google Scholar 

  7. Garcia LA, Carrozza Jr JP. Physiologic evaluation of translesion pressure gradients in peripheral arteries: comparison of pressure wire and catheter-derived measurements. J Interv Cardiol. 2007;20:63–5.

    Article  PubMed  Google Scholar 

  8. Banerjee S, Badhey N, Lichtenwalter C, Varghese C, Brilakis ES. Relationship of walking impairment and ankle-brachial index assessments with peripheral arterial translesional pressure gradients. J Invasive Cardiol. 2011;23:352–6.

    PubMed  Google Scholar 

  9. Bosch JL, Hunink MG. Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease. Radiology. 1997;204:87–96.

    PubMed  CAS  Google Scholar 

  10. Ramaiah V, Gammon R, Kiesz S, et al. Midterm outcomes from the TALON Registry: treating peripherals with SilverHawk: outcomes collection. J Endovasc Ther. 2006;13:592–602.

    Article  PubMed  Google Scholar 

  11. Sharafuddin MJ, Kresowik TF, Hoballah JJ, Nicholson RM, Sharp WJ. Combined direct repair and inline inflow stenting in the management of aortoiliac disease extending into the common femoral artery. Vasc Endovascular Surg. 2011;45:274–82.

    Article  PubMed  Google Scholar 

  12. Zeller T, Sixt S, Rastan A. New techniques for endovascular treatment of peripheral artery disease with focus on chronic critical limb ischemia. Vasa. 2009;38:3–12.

    Article  PubMed  CAS  Google Scholar 

  13. Bradbury AW, Adam DJ, Bell J, et al. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: Analysis of amputation free and overall survival by treatment received. J Vasc Surg. 2010;51:18S–31.

    Article  PubMed  Google Scholar 

  14. Bernstein EF, Rhodes GA, Stuart SH, Coel MN, Fronek A. Toe pulse reappearance time in prediction of aortofemoral bypass success. Ann Surg. 1981;193:201–5.

    Article  PubMed  CAS  Google Scholar 

  15. Dorros G, Jaff MR, Dorros AM, Mathiak LM, He T. Tibioperoneal (outflow lesion) angioplasty can be used as primary treatment in 235 patients with critical limb ischemia: five-year follow-up. Circulation. 2001;104:2057–62.

    Article  PubMed  CAS  Google Scholar 

  16. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40:113–41.

    Article  PubMed  CAS  Google Scholar 

  17. 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  Google Scholar 

  18. Berridge DC, Kessel D, Robertson I. Surgery versus thrombolysis for acute limb ischaemia: initial management. Cochrane Database Syst Rev. 2002;2002:CD002784.

    Google Scholar 

  19. Silva JA, Ramee SR, Collins TJ, et al. Rheolytic thrombectomy in the treatment of acute limb-threatening ischemia: immediate results and six-month follow-up of the multicenter AngioJet registry. Possis Peripheral AngioJet Study AngioJet Investigators. Cathet Cardiovasc Diagn. 1998;45:386–93.

    Article  PubMed  CAS  Google Scholar 

  20. Becker GJ, Katzen BT, Dake MD. Noncoronary angioplasty. Radiology. 1989;170:921–40.

    PubMed  CAS  Google Scholar 

  21. Murphy TP, Ariaratnam NS, Carney Jr WI, et al. Aortoiliac insufficiency: long-term experience with stent placement for treatment. Radiology. 2004;231:243–9.

    Article  PubMed  Google Scholar 

  22. Tetteroo E, van der Graaf Y, Bosch JL, et al. Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac-artery occlusive disease. Dutch Iliac Stent Trial Study Group. Lancet. 1998;351:1153–9.

    Article  PubMed  CAS  Google Scholar 

  23. Klein WM, van der Graaf Y, Seegers J, Moll FL, Mali WP. Long-term cardiovascular morbidity, mortality, and reintervention after endovascular treatment in patients with iliac artery disease: The Dutch Iliac Stent Trial Study. Radiology. 2004;232:491–8.

    Article  PubMed  Google Scholar 

  24. Haulon S, Mounier-Vehier C, Gaxotte V, et al. Percutaneous reconstruction of the aortoiliac bifurcation with the “kissing stents” technique: long-term follow-up in 106 patients. J Endovasc Ther. 2002;9:363–8.

    Article  PubMed  Google Scholar 

  25. Uher P, Nyman U, Lindh M, Lindblad B, Ivancev K. Long-term results of stenting for chronic iliac artery occlusion. J Endovasc Ther. 2002;9:67–75.

    Article  PubMed  Google Scholar 

  26. Stockx L, Poncyljusz W, Krzanowski M, Schroe H, Allocco DJ, Dawkins KD. Express LD vascular stent in the treatment of iliac artery lesions: 24-month results from the MELODIE trial. J Endovasc Ther. 2010;17:633–41.

    Article  PubMed  Google Scholar 

  27. Mwipatayi BP, Thomas S, Wong J, et al. A comparison of covered vs bare expandable stents for the treatment of aortoiliac occlusive disease. J Vasc Surg. 2011;54:1561–70e1.

    Article  PubMed  Google Scholar 

  28. Ponec D, Jaff MR, Swischuk J, et al. The Nitinol SMART stent vs Wallstent for suboptimal iliac artery angioplasty: CRISP-US trial results. J Vasc Interv Radiol. 2004;15:911–8.

    Article  PubMed  Google Scholar 

  29. Timaran CH, Ohki T, Gargiulo 3rd NJ, et al. Iliac artery stenting in patients with poor distal runoff: influence of concomitant infrainguinal arterial reconstruction. J Vasc Surg. 2003;38:479–84. discussion 84–5.

    Article  PubMed  Google Scholar 

  30. Korabathina R, Yadav SS, Coppola JT, Staniloae CS. Transradial approach to lower extremity interventions. Vasc Health Risk Manag. 2010;6:503–9.

    PubMed  Google Scholar 

  31. Etezadi V, Benenati JF, Patel PJ, Patel RS, Powell A, Katzen BT. The reentry catheter: a second chance for endoluminal reentry at difficult lower extremity subintimal arterial recanalizations. J Vasc Interv Radiol. 2010;21:730–4.

    Article  PubMed  Google Scholar 

  32. Muradin GS, Bosch JL, Stijnen T, Hunink MG. Balloon dilation and stent implantation for treatment of femoropopliteal arterial disease: meta-analysis. Radiology. 2001;221:137–45.

    Article  PubMed  CAS  Google Scholar 

  33. Han DK, Shah TR, Ellozy SH, Vouyouka AG, Marin ML, Faries PL. The success of endovascular therapy for all TransAtlantic Society Consensus graded femoropopliteal lesions. Ann Vasc Surg. 2011;25:15–24.

    Article  PubMed  Google Scholar 

  34. Rocha-Singh KJ, Jaff MR, Crabtree TR, Bloch DA, Ansel G. Performance goals and endpoint assessments for clinical trials of femoropopliteal bare nitinol stents in patients with symptomatic peripheral arterial disease. Catheter Cardiovasc Interv. 2007;69:910–9.

    Article  PubMed  Google Scholar 

  35. Kasapis C, Henke PK, Chetcuti SJ, et al. Routine stent implantation vs. percutaneous transluminal angioplasty in femoropopliteal artery disease: a meta-analysis of randomized controlled trials. Eur Heart J. 2009;30:44–55.

    Article  PubMed  Google Scholar 

  36. Krankenberg H, Schluter M, Steinkamp HJ, et al. Nitinol stent implantation versus percutaneous transluminal angioplasty in superficial femoral artery lesions up to 10 cm in length: the femoral artery stenting trial (FAST). Circulation. 2007;116:285–92.

    Article  PubMed  CAS  Google Scholar 

  37. Schillinger M, Sabeti S, Loewe C, et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med. 2006;354:1879–88.

    Article  PubMed  CAS  Google Scholar 

  38. Laird JR, Katzen BT, Scheinert D, et al. Nitinol stent implantation versus balloon angioplasty for lesions in the superficial femoral artery and proximal popliteal artery: twelve-month results from the RESILIENT randomized trial. Circ Cardiovasc Interv. 2010;3:267–76.

    Article  PubMed  Google Scholar 

  39. Sabeti S, Mlekusch W, Amighi J, Minar E, Schillinger M. Primary patency of long-segment self-expanding nitinol stents in the femoropopliteal arteries. J Endovasc Ther. 2005;12:6–12.

    Article  PubMed  Google Scholar 

  40. Gray BH, Grant AA, Kalbaugh CA, et al. The impact of isolated tibial disease on outcomes in the critical limb ischemic population. Ann Vasc Surg. 2010;24:349–59.

    Article  PubMed  Google Scholar 

  41. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 2006;113:e463–654.

    Article  PubMed  Google Scholar 

  42. Sadek M, Ellozy SH, Turnbull IC, Lookstein RA, Marin ML, Faries PL. Improved outcomes are associated with multilevel endovascular intervention involving the tibial vessels compared with isolated tibial intervention. J Vasc Surg. 2009;49:638–43. discussion 43–4.

    Article  PubMed  Google Scholar 

  43. Romiti M, Albers M, Brochado-Neto FC, Durazzo AE, Pereira CA, De Luccia N. Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg. 2008;47:975–81.

    Article  PubMed  Google Scholar 

  44. Gasper WJ, Runge SJ, Owens CD. Management of infrapopliteal peripheral arterial occlusive disease. Curr Treat Options Cardiovasc Med. 2012;14(2):136–48.

    Article  PubMed  Google Scholar 

  45. Randon C, Jacobs B, De Ryck F, Vermassen F. Angioplasty or primary stenting for infrapopliteal lesions: results of a prospective randomized trial. Cardiovasc Intervent Radiol. 2010;33:260–9.

    Article  PubMed  CAS  Google Scholar 

  46. Rastan A, Tepe G, Krankenberg H, et al. Sirolimus-eluting stents vs. bare-metal stents for treatment of focal lesions in infrapopliteal arteries: a double-blind, multi-centre, randomized clinical trial. Eur Heart J. 2011;32:2274–81.

    Article  PubMed  CAS  Google Scholar 

  47. Jude EB, Oyibo SO, Chalmers N, Boulton AJ. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care. 2001;24:1433–7.

    Article  PubMed  CAS  Google Scholar 

  48. Diaz ML, Urtasun F, Barberena J, Aranzadi C, Guillen-Grima F, Bilbao JI. Cryoplasty versus conventional angioplasty in femoropopliteal arterial recanalization: 3-year analysis of reintervention-free survival by treatment received. Cardiovasc Intervent Radiol. 2011;34:911–7.

    Article  PubMed  Google Scholar 

  49. Karthik S, Kessel DO. Cryoplasty–where is the evidence? Acta Chir Belg. 2007;107:500–3.

    PubMed  CAS  Google Scholar 

  50. Laird J, Jaff MR, Biamino G, et al. Cryoplasty for the treatment of femoropopliteal arterial disease: results of a prospective, multicenter registry. J Vasc Interv Radiol. 2005;16:1067–73.

    Article  PubMed  Google Scholar 

  51. Jahnke T. Cryoplasty for the treatment of femoropopliteal arterial disease: will freezing solve the problem of cold feet? J Vasc Interv Radiol. 2005;16:1051–4.

    Article  PubMed  Google Scholar 

  52. Banerjee S, Brilakis ES, Das TS, Lichtenwalter CS. Treatment of complex superficial femoral artery lesions with PolarCath cryoplasty. Am J Cardiol. 2009;104:447–9.

    Article  PubMed  Google Scholar 

  53. Das T, McNamara T, Gray B, et al. Cryoplasty therapy for limb salvage in patients with critical limb ischemia. J Endovasc Ther. 2007;14:753–62.

    Article  PubMed  Google Scholar 

  54. Dake MD, Ansel GM, Jaff MR, et al. Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: twelve-month Zilver PTX randomized study results. Circ Cardiovasc Interv. 2011;4:495–504.

    Article  PubMed  CAS  Google Scholar 

  55. Scheller B, Speck U, Romeike B, et al. Contrast media as carriers for local drug delivery. Successful inhibition of neointimal proliferation in the porcine coronary stent model. Eur Heart J. 2003;24:1462–7.

    Article  PubMed  CAS  Google Scholar 

  56. Scheller B, Speck U, Abramjuk C, Bernhardt U, Bohm M, Nickenig G. Paclitaxel balloon coating, a novel method for prevention and therapy of restenosis. Circulation. 2004;110:810–4.

    Article  PubMed  CAS  Google Scholar 

  57. Albrecht T, Speck U, Baier C, Wolf KJ, Bohm M, Scheller B. Reduction of stenosis due to intimal hyperplasia after stent supported angioplasty of peripheral arteries by local administration of paclitaxel in swine. Invest Radiol. 2007;42:579–85.

    Article  PubMed  CAS  Google Scholar 

  58. Tepe G, Zeller T, Albrecht T, et al. Local delivery of paclitaxel to inhibit restenosis during angioplasty of the leg. N Engl J Med. 2008;358:689–99.

    Article  PubMed  CAS  Google Scholar 

  59. Werk M, Langner S, Reinkensmeier B, et al. Inhibition of restenosis in femoropopliteal arteries: paclitaxel-coated versus uncoated balloon: femoral paclitaxel randomized pilot trial. Circulation. 2008;118:1358–65.

    Article  PubMed  CAS  Google Scholar 

  60. Tepe G, Schmitmeier S, Speck U, Schnorr B, Kelsch B, Scheller B. Advances on drug-coated balloons. J Cardiovasc Surg. 2010;51:125–43.

    CAS  Google Scholar 

  61. Brown DA, Lee EW, Loh CT, Kee ST. A new wave in treatment of vascular occlusive disease: biodegradable stents–clinical experience and scientific principles. J Vasc Interv Radiol. 2009;20:315–24. quiz 25.

    Article  PubMed  Google Scholar 

  62. Biamino G, Schmidt A, Scheinert D. Treatment of SFA lesions with PLLA biodegradable stents: results of the PERSEUS study. J Endovasc Ther. 2005;12:I5.

    Google Scholar 

  63. Peeters P, Bosiers M, Verbist J, Deloose K, Heublein B. Preliminary results after application of absorbable metal stents in patients with critical limb ischemia. J Endovasc Ther. 2005;12:1–5.

    Article  PubMed  Google Scholar 

  64. Bosiers M, Deloose K, Verbist J, Peeters P. First clinical application of absorbable metal stents in the treatment of critical limb ischemia: 12-month results. Vasc Dis Manage. 2006;2:86–91.

    Google Scholar 

  65. Schillinger M, Minar E. Past, present and future of femoropopliteal stenting. J Endovasc Ther. 2009;16 Suppl 1:I147–52.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, VA North Texas Healthcare System, Dallas, TX, USA

    Subhash Banerjee MD & Kimberly Brayton MD

  2. UT Southwestern Medical School, Dallas, TX, USA

    Subhash Banerjee MD & Kimberly Brayton MD

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  1. Subhash Banerjee MD
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  2. Kimberly Brayton MD
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Correspondence to Subhash Banerjee MD .

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Editors and Affiliations

  1. Department of Medicine, Cardiology Section, Director, Cardiovascular Catheterization and Intervention, Yale New Haven Hospital, Director, Invasive Cardiology and Vascular Medicine,, New Haven, Connecticut, USA

    Craig A. Thompson

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Banerjee, S., Brayton, K. (2014). Percutaneous Management of Lower Extremity Arterial Disease: Patient Selection, Techniques, and Technologies. In: Thompson, C. (eds) Textbook of Cardiovascular Intervention. Springer, London. https://doi.org/10.1007/978-1-4471-4528-8_30

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