Skip to main content

The Role of Endovascular Therapy in Peripheral Arterial Disease

  • Chapter
  • First Online:
Diabetes and Peripheral Vascular Disease

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

  • 2394 Accesses

Abstract

Many vascular specialists have embraced endovascular therapy as the first-line treatment for patients with peripheral arterial disease (PAD) and lifestyle-limiting claudication or critical limb ischemia. Compared to surgical bypass, infrainguinal endovascular interventions are associated with reduced durability. These minimally invasive procedures, however, are associated with an improved safety profile and lower morbidity compared to open surgical bypass, even in the setting of significant medical comorbidities. Given the widespread application of endovascular therapy to the treatment of PAD, it is imperative that practitioners involved in the management of patients with PAD and diabetes understand the strengths and weaknesses of endovascular techniques and devices, peri-procedural management, expected results, and outcome measures. This chapter reviews fundamental principles of infrainguinal endovascular therapy for PAD, with specific attention to treatment guidelines and the impact of diabetes and other comorbidities and lesion characteristics on long-term outcome after endovascular therapy.

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. Pande RL, Perlstein TS, Beckman JA, Creager MA. Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999 to 2004. Circulation. 2011;124(1):17–23.

    Article  PubMed  Google Scholar 

  2. McDermott MM. Peripheral arterial disease: epidemiology and drug therapy. Am J Geriatr Cardiol. 2002;11(4):258–66.

    Article  PubMed  Google Scholar 

  3. Varu VN, Hogg ME, Kibbe MR. Critical limb ischemia. J Vasc Surg. 2010;51(1):230–41.

    Article  PubMed  Google Scholar 

  4. LaMuraglia GM, Conrad MF, Chung T, Hutter M, Watkins MT, Cambria RP. Significant perioperative morbidity accompanies contemporary infrainguinal bypass surgery: an NSQIP report. J Vasc Surg. 2009;50(2):299–304, 304.e1–4.

    Google Scholar 

  5. Meltzer AJ, Shrikhande G, Gallagher KA, Aiello FA, Kahn S, Connolly P, McKinsey JF. Heart failure is associated with reduced patency after endovascular intervention for symptomatic peripheral arterial disease. J Vasc Surg. 2012;55(2):353–62.

    Article  PubMed  Google Scholar 

  6. Aiello FA, Khan AA, Meltzer AJ, Gallagher KA, McKinsey JF, Schneider DB. Statin therapy is associated with superior clinical outcomes after endovascular treatment of critical limb ischemia. J Vasc Surg. 2012;55(2):371–9.

    Article  PubMed  Google Scholar 

  7. Gallagher KA, Meltzer AJ, Ravin RA, Graham A, Shrikhande G, Connolly PH, Aiello F, Dayal R, McKinsey JF. Endovascular management as first therapy for chronic total occlusion of the lower extremity arteries: comparison of balloon angioplasty, stenting, and directional atherectomy. J Endovasc Ther. 2011;18(5):624–37.

    Article  PubMed  Google Scholar 

  8. Twine CP, Coulston J, Shandall A, McLain AD. Angioplasty versus stenting for superficial femoral artery lesions. Cochrane Database Syst Rev. 2009;(2):CD006767.

    Google Scholar 

  9. Bachoo P, Thorpe PA, Maxwell H, Welch K. Endovascular stents for intermittent claudication. Cochrane Database Syst Rev. 2010;(1):CD003228.

    Google Scholar 

  10. Kedora J, Hohmann S, Garrett W, Munschaur C, Theune B, Gable D. Randomized comparison of percutaneous Viabahn stent grafts vs prosthetic femoral-popliteal bypass in the treatment of superficial femoral arterial occlusive disease. J Vasc Surg. 2007;45(1):10–6.

    Article  PubMed  Google Scholar 

  11. McCaslin JE, Macdonald S, Stansby G. Cryoplasty for peripheral vascular disease. Cochrane Database Syst Rev. 2007;(4):CD005507.

    Google Scholar 

  12. Schmieder GC, Carroll M, Panneton JM. Poor outcomes with cryoplasty for lower extremity arterial occlusive disease. J Vasc Surg. 2010;52(2):362–8.

    Article  PubMed  Google Scholar 

  13. Spiliopoulos S, Katsanos K, Karnabatidis D, Diamantopoulos A, Kagadis GC, Christeas N, Siablis D. Cryoplasty versus conventional balloon angioplasty of the femoropopliteal artery in diabetic patients: long-term results from a prospective randomized single-center controlled trial. Cardiovasc Intervent Radiol. 2010;33(5):929–38.

    Article  PubMed  Google Scholar 

  14. Zeller T, Rastan A, Schwarzwalder U, et al. Percutaneous peripheral atherectomy of femoropopliteal stenoses using a new-generation device: six-month results from a single-center experience. J Endovasc Ther. 2004;11:676–85.

    Article  PubMed  Google Scholar 

  15. Zeller T, Rastan A, Sixt S, et al. Long-term results after directional atherectomy of femoro-popliteal lesions. J Am Coll Cardiol. 2006;48:1573–8.

    Article  PubMed  Google Scholar 

  16. Zeller T, Frank U, Burgelin K, et al. Initial clinical experience with percutaneous atherectomy in the infragenicular arteries. J Endovasc Ther. 2003;10:987–93.

    Article  PubMed  Google Scholar 

  17. Zeller T, Rastan A, Schwarzwalder U, et al. Midterm results after atherectomy-assisted angioplasty of below-knee arteries with use of the Silverhawk device. J Vasc Interv Radiol. 2004;15:1391–7.

    Article  PubMed  Google Scholar 

  18. Zeller T, Sixt S, Schwarzwalder U, et al. Two year results after directional atherectomy of infrapopliteal arteries with the SilverHawk device. J Endovasc Ther. 2007;14:232–40.

    Article  PubMed  Google Scholar 

  19. McKinsey JF, Goldstein L, Khan HU, Graham A, Rezeyat C, Morrissey NJ, Sambol E, Kent KC. Novel treatment of patients with lower extremity ischemia: use of percutaneous atherectomy in 579 lesions. Ann Surg. 2008;248(4):519–28.

    PubMed  Google Scholar 

  20. Scheinert D, Ulrich M, Scheinert S, Sax J, Braunlich S, Biamino G, et al. Comparison of sirolimus-eluting vs. bare-metal stents for the treatment of infrapopliteal obstructions. Eurointervention. 2006;2:169–74.

    PubMed  Google Scholar 

  21. Duda SH, Pusich B, Richter G, Landwehr P, Oliva VL, Tielbeek A, et al. Sirolimus-eluting stents for the treatment of obstructive superficial femoral artery disease: six-months results. Circulation. 2002;106:1505–9.

    Article  PubMed  CAS  Google Scholar 

  22. Duda SH, Bosiers M, Lammer J, Scheinert D, Zeller T, Tielbeek A, et al. Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the SIROCCO II Trial. J Vasc Interv Radiol. 2005;16:331–8.

    Article  PubMed  Google Scholar 

  23. Duda SH, Bosiers M, Lammer J, Scheinert D, Zeller T, Oliva V, 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 

  24. Lammer J, Bosiers M, Zeller T, Schillinger M, Boone E, Zaugg MJ, Verta P, Peng L, Gao X, Schwartz LB. First clinical trial of nitinol self-expanding everolimus-eluting stent implantation for peripheral arterial occlusive disease. J Vasc Surg. 2011;54(2):394–401.

    Article  PubMed  Google Scholar 

  25. Dake MD, Ansel GM, Jaff MR, Ohki T, Saxon RR, Smouse HB, Zeller T, Roubin GS, Burket MW, Khatib Y, Snyder SA, Ragheb AO, White JK, Machan LS; Zilver PTX Investigators. Zilver PTX Investigators. 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(5):495–504.

    Google Scholar 

  26. Tepe G, Zeller T, Albrecht T, Heller S, Schwarzwälder U, Beregi JP, Claussen CD, Oldenburg A, Scheller B, Speck U. Local delivery of paclitaxel to inhibit restenosis during angioplasty of the leg. N Engl J Med. 2008;358(7):689–99.

    Article  PubMed  CAS  Google Scholar 

  27. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl S):S5-–67.

    PubMed  Google Scholar 

  28. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517–38. Erratum in: J Vasc Surg 2001;33(4):805.

    Article  PubMed  CAS  Google Scholar 

  29. Conte MS, Geraghty PJ, Bradbury AW, Hevelone ND, Lipsitz SR, Moneta GL, Nehler MR, Powell RJ, Sidawy AN. Suggested objective performance goals and clinical trial design for evaluating catheter-based treatment of critical limb ischemia. J Vasc Surg. 2009;50(6):1462–73.e1–3.

    Article  PubMed  Google Scholar 

  30. Conrad MF, Cambria RP, Stone DH, Brewster DC, Kwolek CJ, Watkins MT, Chung TK, LaMuraglia GM. Intermediate results of percutaneous endovascular therapy of femoropopliteal occlusive disease: a contemporary series. J Vasc Surg. 2006;44(4):762–9.

    Article  PubMed  Google Scholar 

  31. Bakken AM, Protack CD, Saad WE, Hart JP, Rhodes JM, Waldman DL, Davies MG. Impact of chronic kidney disease on outcomes of superficial femoral artery endoluminal interventions. Ann Vasc Surg. 2009;23(5):560–8.

    Article  PubMed  Google Scholar 

  32. Apelqvist J, Elgzyri T, Larsson J, Löndahl M, Nyberg P, Thörne J. Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients. J Vasc Surg. 2011;53(6):1582–1588.e2.

    Article  PubMed  Google Scholar 

  33. O’Brien-Irr MS, Dosluoglu HH, Harris LM, Dryjski ML. Outcomes after endovascular intervention for chronic critical limb ischemia. J Vasc Surg. 2011;53(6):1575–81.

    Article  PubMed  Google Scholar 

  34. Haider SN, Kavanagh EG, Forlee M, Colgan MP, Madhavan P, Moore DJ, Shanik GD. Two-year outcome with preferential use of infrainguinal angioplasty for critical ischemia. J Vasc Surg. 2006;43(3):504–12.

    Article  PubMed  Google Scholar 

  35. DeRubertis BG, Faries PL, McKinsey JF, Chaer RA, Pierce M, Karwowski J, Weinberg A, Nowygrod R, Morrissey NJ, Bush HL, Kent KC. Shifting paradigms in the treatment of lower extremity vascular disease: a report of 1000 percutaneous interventions. Ann Surg. 2007;246(3):415–22.

    Article  PubMed  Google Scholar 

  36. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000;31(1 Pt 2):S1–296.

    PubMed  CAS  Google Scholar 

  37. Gallagher KA, Meltzer AJ, Ravin RA, Graham A, Connolly P, Escobar G, Shrikhande G, McKinsey JF. Gender differences in outcomes of endovascular treatment of infrainguinal peripheral artery disease. Vasc Endovascular Surg. 2011;45(8):703–11.

    Article  PubMed  Google Scholar 

  38. Pulli R, Dorigo W, Pratesi G, Fargion A, Angiletta D, Pratesi C. Gender-related outcomes in the endovascular treatment of infrainguinal arterial obstructive disease. J Vasc Surg. 2012;55(1):105–12.

    Article  PubMed  Google Scholar 

  39. Kim IK, Egorova N, Kahn SZ, Meltzer AJ, McKinsey JF. Comparative analysis of femoropopliteal versus tibial lesion characteristics that predict endovascular therapy success. In: Eastern Vascular Society Annual Meeting, September 2011. J Vasc Surg. 2011;54(3):923.

    Google Scholar 

  40. Kim IK, Egorova N, Kahn SZ, Meltzer AJ, Bush HL, McKinsey JF. Lesion characteristics that predict patency of femoral popliteal endovascular intervention: a Novel Lesion Disease Severity Score. In: New England Vascular Society Annual Meeting, September 2011. J Vasc Surg. 2011;54(4):1228.

    Google Scholar 

  41. Meltzer AJ, Kim IK, Khan S, Egorova N, Graham A, McKinsey JF. Comprehensive evaluation of arterial lesion characteristics and their impact on long-term patency after endovascular intervention: the creation of a Novel Lesion Severity Score for Arterial Lesions. In: Society for Vascular Surgery Annual Meeting, Chicago, IL, June 2011. J Vasc Surg. 2011;53(6):107s–8s.

    Google Scholar 

  42. Davies MG, Saad WE, Peden EK, Mohiuddin IT, Naoum JJ, Lumsden AB. Impact of runoff on superficial femoral artery endoluminal interventions for rest pain and tissue loss. J Vasc Surg. 2008;48(3):619–25. Discussion 625–6.

    Article  PubMed  Google Scholar 

  43. Abularrage CJ, Conrad MF, Hackney LA, Paruchuri V, Crawford RS, Kwolek CJ, LaMuraglia GM, Cambria RP. Long-term outcomes of diabetic patients undergoing endovascular infrainguinal interventions. J Vasc Surg. 2010;52(2):314–22.e1–4.

    Article  PubMed  Google Scholar 

  44. DeRubertis BG, Pierce M, Ryer EJ, Trocciola S, Kent KC, Faries PL. Reduced primary patency rate in diabetic patients after percutaneous intervention results from more frequent presentation with limb-threatening ischemia. J Vasc Surg. 2008;47:101–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew J. Meltzer 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

Meltzer, A.J., McKinsey, J.F. (2012). The Role of Endovascular Therapy in Peripheral Arterial 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_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-62703-158-5_9

  • 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