This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Muhs, B. E. Articles by Sheehan, P. Search for Related Content PubMed PubMed Citation Articles by Muhs, B. E. Articles by Sheehan, P. Social Bookmarking                         What's this?

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

References

• Pukin L. Devices and techniques for endovascular surgery: catheters, stents, coated stents, and stented grafts. Mt Sinai J Med 2003;70(6):386-392.[Medline] [Order article via Infotrieve]
• Pomposelli FB Jr, Jepsen SJ, Gibbons GW, et al. Efficacy of the dorsal pedal bypass for limb salvage in diabetic patients: short-term observations. J Vasc Surg 1990;11(6):745-751 (see also discussion 751-2).[CrossRef][Medline] [Order article via Infotrieve]
• Gibbons GW, Burgess AM, Guadagnoli E, et al. Return to well-being and function after infrainguinal revascularization. J Vasc Surg 1995;21(1):35-44 (see also discussion 44-5).[CrossRef][Medline] [Order article via Infotrieve]
• Faries PL, LoGerfo FW, Hook SC, et al. The impact of diabetes on arterial reconstructions for multilevel arterial occlusive disease. Am J Surg 2001;181(3):251-255.[CrossRef][Medline] [Order article via Infotrieve]
• Faries PL, Logerfo FW, Arora S, et al. A comparative study of alternative conduits for lower extremity revascularization: allautogenous conduit versus prosthetic grafts. J Vasc Surg 2000;32(6):1080-1090.[CrossRef][Medline] [Order article via Infotrieve]
• Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction. Description of a new technique and a preliminary report of its application. Circulation 1964;30:654-670.
• Weiss VJ, Lumsden AB. Minimally invasive vascular surgery: review of current modalities. World J Surg 1999;23(4):406-414.[CrossRef][Medline] [Order article via Infotrieve]
• Johnston KW, Rae M, Hogg-Johnston SA, et al. 5-year results of a prospective study of percutaneous transluminal angioplasty. Ann Surg 1987;206(4):403-413.[Medline] [Order article via Infotrieve]
• Johnston KW. Iliac arteries: reanalysis of results of balloon angioplasty. Radiology 1993;186(1):207-212.[Abstract/Free Full Text]
• Palmaz JC, Laborde JC, Rivera FC. Stenting of the iliac arteries with the Palmaz stent: experience from a multi center trial. Cardiovasc Intervent Radiol 1992;15(5):291-297.[Medline] [Order article via Infotrieve]
• Bosch JL, Hunink MG. Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease. Radiology 1997;204(1):87-96.[Abstract/Free Full Text]
• Brothers TE, Greenfield LJ. Long-term results of aortoiliac reconstruction. J Vasc Interv Radiol 1990;1(1):49-55.[Medline] [Order article via Infotrieve]
• Association AD. Peripheral arterial disease in people with diabetes. Diabetes Care 2003;26(12):3333-3341.[Free Full Text]
• TransAtlantic Inter-Society Consensus (TASC). Management of peripheral arterial disease (PAD). Eur J Vasc Endovasc Surg 2000;19(Suppl A):xxviii, S1-S250.
• Surowiec SM, Davies MG, Eberly SW, et al. Percutaneous angioplasty and stenting of the superficial femoral artery. J Vasc Surg 2005;41(2):269-278.[CrossRef][Medline] [Order article via Infotrieve]
• van der Zaag ES, Legemate DA, Prins MA, et al. Angioplasty or bypass for superficial femoral artery disease? A randomised controlled trial. Eur J Vasc Endovasc Surg 2004;28(2):132-137.[Medline] [Order article via Infotrieve]
• Lofberg AM, Karacagil S, Ljungman C, et al. Percutaneous transluminal angioplasty of the femoropopliteal arteries in limbs with chronic critical lower limb ischemia. J Vasc Surg 2001;34(1):114-121.[CrossRef][Medline] [Order article via Infotrieve]
• Faglia E, Dalla Paola L, Clerici G, et al. Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur J Vasc Endovasc Surg 2005;29(6):620-627.[CrossRef][Medline] [Order article via Infotrieve]
• Feiring AJ, Wesolowski AA, Lade S. Primary stent-supported angioplasty for treatment of below-knee critical limb ischemia and severe claudication: early and one-year outcomes. J Am Coll Cardiol 2004;44(12):2307-2314.[Abstract/Free Full Text]
• Parsons RE, Suggs WD, Lee JJ, et al. Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: do the results justify an attempt before bypass grafting? J Vasc Surg 1998;28(6):1066-1071.[CrossRef][Medline] [Order article via Infotrieve]
• Clair DG, Dayal R, Faries PL, et al. Tibial angioplasty as an alternative strategy in patients with limb-threatening ischemia. Ann Vasc Surg 2005;19(1):63-68.[CrossRef][Medline] [Order article via Infotrieve]
• Fava M, Loyola S, Polydorou A, et al. Cryoplasty for femoropopliteal arterial disease: late angiographic results of initial human experience. J Vasc Interv Radiol 2004;15(11):1239-1243.[CrossRef][Medline] [Order article via Infotrieve]
• Rilinger N, Gorich J, Scharrer-Pamler R, et al. Percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease using a transluminal endatherectomy catheter (TEC): initial results and angiographic follow-Up. Cardiovasc Intervent Radiol 1997;20(4):263-267.[CrossRef][Medline] [Order article via Infotrieve]
• 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(6):676-685.[CrossRef][Medline] [Order article via Infotrieve]
• Biamino G. The excimer laser: science fiction fantasy or practical tool? J Endovasc Ther 2004;11(Suppl 2):II207-II222.
• Visona A, Perissinotto C, Lusiani L, et al. Percutaneous excimer laser angioplasty of lower limb vessels: results of a prospective 24-month follow-up. Angiology 1998;49(2):91-98.
• Steinkamp HJ, Rademaker J, Wissgott C, et al. Percutaneous transluminal laser angioplasty versus balloon dilation for treatment of popliteal artery occlusions. J Endovasc Ther 2002;9(6):882-888.[CrossRef][Medline] [Order article via Infotrieve]
• Steinkamp HJ, Wissgott C, Rademaker J, et al. Short (1-10 cm) superficial femoral artery occlusions: results of treatment with excimer laser angioplasty. Cardiovasc Intervent Radiol 2002;25(5):388-396.[CrossRef][Medline] [Order article via Infotrieve]
• Bosiers M, Peeters P, Elst FV, et al. Excimer laser assisted angioplasty for critical limb ischemia: results of the LACI Belgium Study. Eur J Vasc Endovasc Surg 2005;29(6):613-619.[CrossRef][Medline] [Order article via Infotrieve]
• Sousa JE, Costa ME, 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(2):192-195.[Abstract/Free Full Text]
• Sousa JE, Costa ME, Abizaid AC, et al. Sustained suppression of neointimal proliferation by sirolimus-eluting stents: one-year angiographic and intravascular ultrasound follow-up. Circulation 2001;104(17):2007-2011.[Abstract/Free Full Text]
• 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(12):1505-1509.[Abstract/Free Full Text]
• Duda SH, Bosiers M, Lammer J, et al. Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the SIROCCO II trial. J Vasc Interv Radiol 2005;16(3):331-338.[Medline] [Order article via Infotrieve]
• Duda SH, Poerner TC, Wiesinger B, et al. Drug-eluting stents: potential applications for peripheral arterial occlusive disease. J Vasc Interv Radiol 2003;14(3):291-301.[Medline] [Order article via Infotrieve]
• Bolia A, Brennan J, Bell PR. Recanalisation of femoro-popliteal occlusions: improving success rate by subintimal recanalisation. Clin Radiol 1989;40(3):325.
• Vraux H, Hammer F, Verhelst R, et al. Subintimal angioplasty of tibial vessel occlusions in the treatment of critical limb ischaemia: mid-term results. Eur J Vasc Endovasc Surg 2000;20(5):441-446.[CrossRef][Medline] [Order article via Infotrieve]
• Reekers JA, Kromhout JG, Jacobs MJ. Percutaneous intentional extraluminal recanalisation of the femoropopliteal artery. Eur J Vasc Surg 1994;8(6):723-728.[CrossRef][Medline] [Order article via Infotrieve]
• Lazaris AM, Tsiamis AC, Fishwick G, et al. Clinical outcome of primary infrainguinal subintimal angioplasty in diabetic patients with critical lower limb ischemia. J Endovasc Ther 2004;11(4):447-453.[CrossRef][Medline] [Order article via Infotrieve]

The International Journal of Lower Extremity Wounds, Vol. 5, No. 1, 35-39 (2006)
DOI: 10.1177/1534734606286473


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. K. Lazarides The Impact of Interventional Management on Healing of Ischemic Foot Lesions International Journal of Lower Extremity Wounds, June 1, 2009; 8(2): 64 - 66. [PDF]

				Y. B. Pride, D. S. Pinto, and L. A. Garcia A novel approach using atherectomy for chronic total occlusion of the brachial artery: a case report Vascular Medicine, August 1, 2007; 12(3): 207 - 210. [Abstract] [PDF]

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Muhs, B. E. Articles by Sheehan, P. Search for Related Content PubMed PubMed Citation Articles by Muhs, B. E. Articles by Sheehan, P. Social Bookmarking                         What's this?