At present, the use of drug coated balloons (DCB) in femoropopliteal territory is more and more frequent. However, when it comes to treating moderate to severe calcification, the evidence is still limited. Using a peripheral artery calcification scoring system (PACSS) has been associated to clinical outcomes after DCB angioplasty for femoropopliteal lesions. The system categorizes…
Retrograde Tibial Access for Endovascular Treatment of Femoropopliteal Occlusions: Is it a Safe Strategy?
Endovascular recanalization of femoropopliteal occlusions continues to be one of the initial therapeutic strategies to treat this pathology. The anterograde approach via the common femoral is the most frequently used. However, it is not always viable, especially in long occlusions with severe calcification or when the femoral artery cannot be reached. In these cases, the…
Deep Vein Arterialization: Have We Conquered “Non-Revascularizable” Critical Limb Ischemia?
Deep vein Arterialization in patients with critical “non-revascularizable” limb ischemia. We are familiar with the poor quality of life and elevated mortality of patients with chronic limb-threatening ischemia (CLTI). In its last stages (nearly terminal), revascularization (either surgical or endovascular) has been shown to reduce amputation incidence. However, similarly to heart disease and other vascular scenarios,…
Relationship Between Medical Treatment and Long-Term Clinical Results after Peripheral Vascular Intervention
Peripheral arterial disease (PAD) is one of the consequences of atherosclerosis, and it can cause pain in the limbs or tissue loss. Its treatment includes lifestyle changes such as exercise, statin therapy, antiplatelet therapy, antihypertensive medication (mainly ACE inhibitors or ARBs), and revascularization strategy. One in five patients with PAD will have experienced acute myocardial…
Arterial Patency in Femoropopliteal Disease with Drug-Eluting Balloons
Follow-up of drug-coated balloon angioplasty in femoropopliteal disease in a real-world population. Using drug-releasing devices has decreased the rate of restenosis in obstructive femoropopliteal lesions compared with conventional balloons or conventional stents (bare-nitinol stent, BNS). Both in the placement of BNS and of drug-eluting stents (DES) there is a mechanical risk of stent fracture or…
Stent Revascularization in Femoropopliteal Disease: An Analysis of Clustered Randomized Trials
A study compared pooled data of claudication and critical ischemia patients treated with stenting vs. by-pass surgery in femoropopliteal disease. The main objective of revascularization in femoropopliteal disease is to improve the quality of life and functional capacity of claudication patients who did not respond to medical treatment, and to save the affected limb in…
What Is the Best Strategy for Moderately Complex Femoropopliteal Lesions?
At present, PCI is the preferred treatment for femoropopliteal lesions and drug coated balloons (DCB) have shown good performance. However, they have not yet been shown superior to bare-metal stents (BMS). This study compared randomized trials IN.PACT SFA I/II and IN.PACT JAPAN including 288 patients vs. the prospective Complete SE and DURABILITY II with 483…
IN.PACT Study | Should We Start Using DCBs More Frequently in Cases of Femoropopliteal Disease?
With the new devices (drug-eluting balloons [DEB], drug-eluting stents [DES], and atherotomes) percutaneous treatment is becoming the first line of approach for femoropopliteal disease, especially when dealing with not very long total occlusions. Randomized studies and registries on the use of drug-coated balloons (DCB) in femoropopliteal disease are currently available, but their evolution beyond 2…
Safety of Atherectomy in Femoropopliteal Disease
Peripheral artery disease hinders patient quality of life extensively. In advanced stages, such as critical lower limbs ischemia (CLLI), it could yield an increased risk in major cardiovascular events, as well as limb-related events (amputation or repeat revascularization), making treatment with revascularization paramount in these cases. Calcification is a predictor of revascularization failure, which is…
Drug Coated Balloons in Femoropopliteal Territory: Predictors of Failed Patency
Endovascular treatment in femoropopliteal territory has become the strategy of choice over time, with diverse devices; among others, drug coated balloons (DCB). DBS are meant to provide the antiproliferation effect of drugs while reducing exposure of a specific artery segment to a strange body. Even though the number of studies on DCB effectiveness has been…
EMINENT Trial | Stent Eluvia vs BMS in Femoropopliteal Territory
Endovascular therapy in femoropopliteal territory has become the standard, mainly with self-expanding stents, aimed at preventing early vascular recoil and late constrictive remodeling. Randomized studies have shown that the use of Paclitaxel drug eluting stents (DES) reduces the number of new revascularizations (even though these studies compared mostly against conventional balloons, which is why we…