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Minimally Invasive Revascularization Strategies for Chronic Lower Limb Ischemia

Division of Vascular Surgery, New York University School of Medicine, New York, muhsb01{at}med.nyu.edu

Paul J. Gagne, MD

Division of Vascular Surgery, New York University School of Medicine, New York

Thomas Maldonado, MD

Division of Vascular Surgery, New York University School of Medicine, New York

Peter Sheehan, MD

Department of Medicine, Diabetes Foot and Ankle Center, Hospital for Joint Disease, New York

Lower extremity wounds resulting from ischemia are increasingly becoming a common indication for surgical revascularization. Techniques in minimally invasive vascular surgery for the treatment of lower extremity chronic ischemia have expanded rapidly in recent years. The current standard of care with which all new modalities should be compared is the restoration of arterial flow via direct arterial revascularization using the autogenous reversed saphenous vein that can yield limb salvage rates of approximately 95%. Percutaneous transluminal angioplasty and stenting (PTA/S), cryoplasty, catheter-directed atherectomy, laser-assisted PTA/S, drug-eluting stents, and subintimal angioplasty are emerging minimally invasive modalities used for the treatment of lower extremity ischemia. Early success rates using many of these techniques have been promising. The outcomes of randomized controlled trials with long-term follow-ups are needed to make confident remarks about the effectiveness of these techniques.

Key Words: lower limb ischemia • angioplasty • stents • atherectomy • minimally invasive • drug-eluting stents • Eximer laser • subintimal angioplasty

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