Skip to main content

Evolving Technology in the Treatment of Peripheral Vascular Disease

  • Chapter
  • First Online:
Diabetes and Peripheral Vascular Disease

Part of the book series: Contemporary Diabetes ((CDI))

  • 2348 Accesses

Abstract

Endovascular management has largely become the initial and primary treatment modality for peripheral vascular disease of the lower extremity. This has been a result of extensive advancements in catheter-based interventions which continues to evolve at an exceptional pace. The development of drug eluting balloons and stents is a continuum of this technological ingenuity and may prove to offer the best clinical results yet. Since the inception of these treatment modalities, there has been much fervor and high expectations. This chapter provides information from the initial use of these biological agents, the mechanism of action from a molecular and cellular level to clinical applications in both small and large clinical trials looking at infrainguinal interventions. New technologies currently being studied but yet to have made their debut in the armamentarium of vascular interventionists will also be examined, thereby, providing a view of things to come.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Sousa JE, Costa MA, Abizaid A, et al. Lack of neointimal proliferation after implantation of sirolimus-coated stents in human coronary arteries. A quantitative coronary angiography and three-dimensional intravascular ultrasound study. Circulation. 2001;103:192–5.

    Article  PubMed  CAS  Google Scholar 

  2. Sousa JE, Costa MA, Abizaid AC, et al. Sustained suppression of neointimal proliferation by sirolimus-eluting stents: one-year angiographic and intravascular ultrasound follow-up. Circulation. 2001;104:2007–11.

    Article  PubMed  CAS  Google Scholar 

  3. Serruys PW, Kutryk MJB, Ong ATL. Coronary-artery stents. N Engl J Med. 2006;354:483–95.

    Article  PubMed  CAS  Google Scholar 

  4. Duda SH, Pusich B, Richter G, et al. Sirolimus-eluting stents for the treatment of obstructive superficial femoral artery disease: six-month results. Circulation. 2002;106:1505–9.

    Article  PubMed  CAS  Google Scholar 

  5. Groth CG, Backman L, Morales JM, et al. Sirolimus (rapamycin)-based therapy in human renal transplantation: similar efficacy and different toxicity compared with cyclosporine. Sirolimus European renal transplant study group. Transplantation. 1999;67:1036–42.

    Article  PubMed  CAS  Google Scholar 

  6. Poon M, Marx SO, Gallo R, et al. Rapamycin inhibits vascular smooth muscle cell migration. J Clin Invest. 1996;98:2277–83.

    Article  PubMed  CAS  Google Scholar 

  7. Marx SO, Jayaraman T, Go LO, Marks AR. Rapamycin-FKBP inhibits cell cycle regulators of proliferation in vascular smooth muscle cells. Circ Res. 1995;76:412–7.

    Article  PubMed  CAS  Google Scholar 

  8. Duda SH, Bosiers M, Lammer J, et al. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial. J Endovasc Ther. 2006;13:701–10.

    Article  PubMed  Google Scholar 

  9. Zeller T, Schmitmeier S, Tepe G, Rastan A. Drug-coated balloons in the lower limb. J Cardiovasc Surg. 2011;52:235–43.

    CAS  Google Scholar 

  10. Tepe G, Schmitmeier S, Zeller T. Drug-coated balloons in the peripheral arterial disease. EuroIntervention. 2011;7:K70–6.

    Article  PubMed  Google Scholar 

  11. Schnorr B, Speck U, Scheller B. Review of clinical data with Paccocath™-coated balloon catheters. Minerva Cardioangiol. 2011;59:431–45.

    PubMed  CAS  Google Scholar 

  12. 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 

  13. Dake MD, Scheinert D, Tepe G, et al. Nitinol stents with polymer-free paclitaxel coating for lesions in the superficial femoral and popliteal arteries above the knee: twelve-month safety and effectiveness results from the Zilver PTX single-arm clinical study. J Endovasc Ther. 2011;18:613–23.

    Article  PubMed  Google Scholar 

  14. Lammer J, Bosiers M, Zeller T, et al. First clinical trial of nitinol self-expanding everolimus-eluting stent implantation for peripheral arterial occlusive disease. J Vasc Surg. 2011;54:394–401.

    Article  PubMed  Google Scholar 

  15. Lammer J, Scheinert D, Vermassen F, et al. Pharmacokinetic analysis after implantation of everolimus-eluting stent self-expanding stents in the peripheral vasculature. J Vasc Surg. 2012;55:400–5.

    Article  PubMed  Google Scholar 

  16. Zhao HQ, Jayasinghe D, Hossainy S, Schwartz LB. A theoretical model to characterize the drug release behavior of drug-eluting stents with durable polymer matrix coating. J Biomed Mater Res A. 2012;100:120–4.

    PubMed  Google Scholar 

  17. Tepe G, Schmehl J, Heller S, et al. Drug eluting stents versus PTA with GP IIb/IIIa blockade below the knee in patients with current ulcers-The BELOW study. J Cardiovasc Surg. 2010;51:203–12.

    CAS  Google Scholar 

  18. Bosiers M, Deloose K, Keirse K, et al. Are drug-eluting stents the future of SFA treatment? J Cardiovasc Surg. 2010;51:115–9.

    CAS  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. Chan YC, Cheng SW. Drug-eluting stents and balloons in peripheral arterial disease: evidence so far. Int J Clin Pract. 2011;65:664–8.

    Article  PubMed  CAS  Google Scholar 

  21. Bosiers M, Cagiannos C, Deloose K, et al. Drug-eluting stents in the management of peripheral arterial disease. Vasc Health Risk Manag. 2008;4:553–9.

    PubMed  Google Scholar 

  22. Schwartz RS, Holmes DR, Topol EJ. The restenosis paradigm revisited: an alternative proposal for cellular mechanisms. J Am Coll Cardiol. 1992;20:1284–93.

    Article  PubMed  CAS  Google Scholar 

  23. Gray WA, Granada JF. Drug-coated balloons for the prevention of vascular restenosis. Circulation. 2010;121:2627–80.

    Article  Google Scholar 

  24. Granada JF, Milewski K, Zhao H, et al. Vascular response to zotarolimus-coated balloons in the injured superficial femoral arteries of the familial hypercholesterolemic swine. Circ Cardiovasc Interv. 2011;4:447–55.

    Article  PubMed  CAS  Google Scholar 

  25. Wani MC, Taylor HL, Wall ME, Coggan P, McPhail AT. Plant antitumor agents. VI. The isolation and structure of taxol, a novel antileukemic and antitumor agent from Taxus brevifolia. J Am Chem Soc. 1971;93:2325–7.

    Article  PubMed  CAS  Google Scholar 

  26. Rowinsky EK, Donehower RC. Paclitaxel (Taxol). N Engl J Med. 1995;332:1004–14.

    Article  PubMed  CAS  Google Scholar 

  27. Crossin KL, Carney DH. Microtubule stabilization by taxol inhibits initiation of DNA synthesis by thrombin and by epidermal growth factor. Cell. 1981;27(2 Pt 1):341–50.

    Article  PubMed  CAS  Google Scholar 

  28. Axel DI, Kunert W, Goggelmann C, et al. Paclitaxel inhibits arterial smooth muscle cell proliferation and migration in vitro and in vivo using local drug delivery. Circulation. 1997;96:636–45.

    Article  PubMed  CAS  Google Scholar 

  29. Cortese B, Bertoletti A. Paclitaxel coated balloons for coronary artery interventions: a comprehensive review of preclinical and clinical data. Int J Cardiol. 2011.

    Google Scholar 

  30. Scheller B, Speck U, Abramjuk C, et al. Paclitaxel balloon coating, a novel method for prevention and therapy of restenosis. Circulation. 2004;110:810–4.

    Article  PubMed  CAS  Google Scholar 

  31. 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 model. Eur Heart J. 2003;24:1462–7.

    Article  PubMed  CAS  Google Scholar 

  32. Scheller B, Speck U, Schmitt A, et al. Addition of paclitaxel to contrast media prevents restenosis after coronary stent implantation. J Am Coll Cardiol. 2003;42:1415–20.

    Article  PubMed  CAS  Google Scholar 

  33. Cremers B, Speck U, Kaufels N, et al. Drug-eluting balloon: very short-term exposure and overlapping. Thromb Haemost. 2009;101:201–6.

    PubMed  CAS  Google Scholar 

  34. Kelsch B, Schneller B, Biederman M, et al. Dose response to paclitaxel-coated balloon catheters in the porcine coronary overstretch and stent implantation model. Invest Radiol. 2011;46:255–63.

    Article  PubMed  CAS  Google Scholar 

  35. Schiff PB, Fant J, Horwitz SB. Promotion of microtubule assembly in vitro by taxol. Nature. 1979;277:665–7.

    Article  PubMed  CAS  Google Scholar 

  36. Scheller B, Hehrlein C, Bocksch W, et al. Treatment of coronary in-stent restenosis with paclitaxel-coated balloon catheters. N Engl J Med. 2006;355:2113–24.

    Article  PubMed  CAS  Google Scholar 

  37. Albrecht T, Speck U, Baier C, et al. 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 

  38. Milewski K, Tellez A, Abodi MS, et al. Paclitaxel-iopromide coated balloon followed by “bail-out” bare metal stent in porcine iliofemoral arteries: first report on biological effects in peripheral circulation. EuroIntervention. 2011;7:362–8.

    Article  PubMed  Google Scholar 

  39. 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 

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

    Article  PubMed  CAS  Google Scholar 

  41. Scheller B. Opportunities and limitations of drug-coated balloons in interventional therapies. Herz. 2011;36:232–40.

    Article  PubMed  CAS  Google Scholar 

  42. Manzi M, Cester G, Palena M. Paclitaxel-coated balloon angioplasty for lower extremity revascularization: a new way to fight in-stent restenosis. J Cardiovasc Surg. 2010;51:567–71.

    CAS  Google Scholar 

  43. Schwarzwalder U, Zeller T. Below-the-knee revascularization. Advanced techniques. J Cardiovasc Surg. 2009;50:627–34.

    CAS  Google Scholar 

  44. Tepe G, Schmitmeier S, Schnorr B, et al. Advances in drug-coated balloons. J Cardiovasc Surg. 2010;51:125–43.

    CAS  Google Scholar 

  45. Wood SC, Tang X, Tesfamariam B. Paclitaxel potentiates inflammatory cytokine-induced prothrombotic molecules in endothelial cells. J Cardiovasc Surg. 2010;55:276–85.

    CAS  Google Scholar 

  46. Nakazawa G, Granada JF, Alviar CL, et al. Anti-CD34 antibodies immobilized on the surface of sirolimus-eluting stents enhance stent endothelialization. JACC Cardiovasc Interv. 2010;3:68–75.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Francesco A. Aiello M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media New York

About this chapter

Cite this chapter

Aiello, F.A., Morrissey, N.J. (2012). Evolving Technology in the Treatment of Peripheral Vascular Disease. In: Shrikhande, G., McKinsey, J. (eds) Diabetes and Peripheral Vascular Disease. Contemporary Diabetes. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-158-5_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-62703-158-5_16

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-62703-157-8

  • Online ISBN: 978-1-62703-158-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics