Endovascular interventions in iliac and infrainguinal occlusive artery disease.
Percutaneous endovascular procedures are increasingly applied to treat symptomatic peripheral occlusive artery disease. While the primary technical success and recanalization rates in iliac and infrainguinal interventions are high, differences in the long-term patency rates exist with respect to the anatomic localization, separating the iliac, femoropopliteal, and infrapopliteal arterial regions. In iliac arteries, even complex lesions can be recanalized with good long-term patency rates, especially when using self-expanding nitinol stents. In the infrainguinal arteries the method of choice is still under debate (e.g., balloon angioplasty vs stent implantation). A high restenosis rate represents one of the major limitations in femoropopliteal and infrapopliteal interventions. Therefore, additional methods and treatment strategies for peripheral interventions with the potential for future applications are under investigation and will be discussed such as drug-eluting stents, brachytherapy, subintimal angioplasty, laser angioplasty, atherectomy/thrombectomy, cutting balloon, polytetrafluoroethylene (PTFE)-covered stent grafts, biodegradable stents, and cryoplasty. The increasing amount of data on successful peripheral interventions supports the necessity to adapt and reevaluate the current consensus guidelines that were put together in 2000.
Ruef
Johannes
J
Red Cross Hospital Cardiology Center, Frankfurt, Germany. j.ruef@kardiocentrum-ffm.de
Hofmann
Manfred
M
Haase
Jürgen
J
D000800:Angioplasty, Balloon; D017222:Angioplasty, Balloon, Laser-Assisted; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D017073:Atherectomy; D001918:Brachytherapy; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007083:Iliac Artery; D007866:Leg / Q000098:blood supply*; D011150:Popliteal Artery / Q000601:surgery; D015607:Stents; D014654:Vascular Patency