title: Bifurcation stenting after failed angioplasty of infrapopliteal arteries in critical limb ischemia: techniques and short-term follow-up.
abstract: OBJECTIVE
  To report on the efficacy of drug eluting stents (DES) in below the knee lesions involving arterial bifurcations after failed angioplasty.
  
  
  BACKGROUND
  DES have become a mainstay in the treatment of below the knee lesions. However, little is known about the efficacy of DES in infrapopliteal lesions involving the arterial bifurcations. This is the first report on the endovascular treatment of below-the knee bifurcations.
  
  
  METHODS
  11 patients with critical lower limb ischemia and complex infrapopliteal atherosclerotic disease underwent provisional DES placement in infrapopliteal bifurcation lesions. Clinical and angiographic follow-up data were prospectively collected in all patients.
  
  
  RESULTS
  Technical success was achieved in all cases. After 6 months, the two vessel primary patency (2VPP) rate was 54.5% and the 1VPP rate was 81.8%. Between baseline and the follow-up, mean ankle-brachial index increased from 0.31 ± 0.10 to 0.68 ± 0.16, and mean Rutherford-Becker class decreased from 4.73 ± 0.20 to 3.00 ± 1.41 (P < 0.001 for both comparisons).
  
  
  CONCLUSIONS
  Bifurcation stenting techniques, that are described for the coronary arteries can be also performed in the infrapopliteal arteries. However, early reocclusion was frequent in this case series, when stenting was performed in a bail-out setting. If balloon angioplasty alone leads to no sufficient results in bifurcation lesions, a single stent strategy could also be considered.
authors: Center of Vascular Medicine, Park Hospital Leipzig, Germany.
authors: Martin
authors: M
authors: Werner
authors: Susanne
authors: S
authors: Scheinert
authors: Yvonne
authors: Y
authors: Bausback
authors: Sven
authors: S
authors: Bräunlich
authors: Matthias
authors: M
authors: Ulrich
authors: Michael
authors: M
authors: Piorkowski
authors: Dierk
authors: D
authors: Scheinert
authors: Andrej
authors: A
authors: Schmidt
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D055109:Ankle Brachial Index; D016638:Critical Illness; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D011474:Prosthesis Design; D011859:Radiography; D019233:Retreatment; D016879:Salvage Therapy; D013997:Time Factors; D017211:Treatment Failure; D014654:Vascular Patency
keywords: below the knee arteries; bifurcation; bifurcation stenting; critical limb ischemia; drug eluting stent; infrapopliteal atherosclerotic disease