Endovascular surgery in the treatment of lower limb ischemia

Chernyavin M.P.; Zakaryan N.V.; Kazantsev A.N.; Belov Yu.V.

doi:https://doi.org/10.17116/kardio20251801196

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Abstract:

Chronic lower limb ischemia is one of the most common manifestations of atherosclerotic disease in elderly patients. Undiagnosed ischemia can lead not only to trophic disorders, but also to amputation. Currently, percutaneous minimally invasive surgery is common for these patients. The authors reviewed modern methods of endovascular treatment of occlusive-stenotic lesions of lower limb arteries.

Keywords:

chronic lower limb ischemia

endovascular intervention

stenting of lower limb arteries

selective regional thrombolysis

atherectomy devices

Authors:

Chernyavin M.P.

Clinical Hospital No. 1 (Volynskaya) of the Presidential Administration

ORCID: 0000-0001-6122-4639

Zakaryan N.V.

Clinical Hospital No. 1 (Volynskaya) of the Presidential Administration

ORCID: 0000-0001-9670-4296

Kazantsev A.N.

Korolev Regional Clinical Hospital

SPIN RSCI: 8396-1845
Scopus AuthorID: 57196122083
ORCID: 0000-0002-1115-609X

Belov Yu.V.

Petrovsky National Research Center of Surgery;
Sechenov First Moscow State Medical University

SPIN RSCI: 2740-1439
Scopus AuthorID: 7101862336
ResearcherID: 7101862336
ORCID: 0000-0002-9280-8845

Received:

03.07.2023

Accepted:

26.07.2023

Close metadata

References:

Lyden SP, Smouse HB. TASC II and the endovascular management of infrainguinal disease. J Endovasc Ther. 2009;16(Suppl 2):5-18.
Dayama A, Tsilimparis N, Kolakowski S, et al. Clinical outcomes of bypass-first versus endovascular-first strategy in patients with chronic limb-threatening ischemia due to infrageniculate arterial disease. J Vasc Surg. 2019;69:156-163.e151.
Adam DJ, Beard JD, Cleveland T, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366(9501):1925-1934.
Conte MS, Bandyk DF, Clowes AW, et al. Results of PREVENT III: a multicenter, randomized trial of edifoligide for the prevention of vein graft failure in lower extremity bypass surgery. J Vasc Surg. 2006;43(4):742-751; discussion 751.
Iida O, Nakamura M, Yamauchi Y, et al. 3-Year Outcomes of the OLIVE Registry, a Prospective Multicenter Study of Patients With Critical Limb Ischemia: A Prospective, Multi-Center, Three-Year Follow-Up Study on Endovascular Treatment for Infra-Inguinal Vessel in Patients With Critical Limb Ischemia. JACC Cardiovasc Interv. 2015;8(11):1493-1502.
Belov YuV, Vinokurov IA. The concept of an approach to the surgical treatment of critical ischemia of the lower extremities. Russian Journal of Cardiology and Cardiovascular Surgery. 2015;8(5):9-13. (In Russ.). https://doi.org/10.17116/kardio2015859-13
Donas KP, Torsello G, Schwindt A, et al. Below knee bare nitinol stent placement in high-risk patients with critical limb ischemia is still durable after 24 months of follow-up. Journal of vascular surgery. 2010;52(2):356-361.
Garg K, Kaszubski PA, Moridzadeh R, et al. Endovascular-first approach is not associated with worse amputation-free survival in appropriately selected patients with critical limb ischemia. J Vasc Surg. 2014;59(2):392-399.
Karnabatidis D, Spiliopoulos S, Diamantopoulos A, et al. Primary everolimus-eluting stenting versus balloon angioplasty with bailout bare metal stenting of long infrapopliteal lesions for treatment of critical limb ischemia. J Endovasc Ther. 2011;18(1):1-12.
Scheinert D, Katsanos K, Zeller T, et al. A prospective randomized multicenter comparison of balloon angioplasty and infrapopliteal stenting with the sirolimus-eluting stent in patients with ischemic peripheral arterial disease:1-year results from the ACHILLES trial. J Am Coll Cardiol. 2012;60(22):2290-2295.
Zeller T, Baumgartner I, Scheinert D, et al. Drug-eluting balloon versus standard balloon angioplasty for infrapopliteal arterial revascularization in critical limb ischemia:12-month results from the IN.PACT DEEP randomized trial. J Am Coll Cardiol. 2014;64(15):1568-1576.
Afonkina MV, Martynova OYu, Belov YuV, et al. Predictors of thrombosis and death in patients with Covid-19 after thrombectomy from lower limb arteries. Rossijskij kardiologicheskij zhurnal. 2022;27(12):50-56. (In Russ.).
Kudo T, Chandra FA, Ahn SS. Long-term outcomes and predictors of iliac angioplasty with selective stenting. J Vasc Surg. 2005;42(3):466-475. https://doi.org/10.1016/j.jvs.2005.05.002
Balzer JO, Thalhammer A, Khan V, et al. Angioplasty of the pelvic and femoral arteries in PAOD: results and review of the literature. Eur J Radiol. 2010;75(1):48-56. https://doi.org/10.1016/j.ejrad.2010.04.016
Kudo T, Chandra FA, Ahn SS. The effectiveness of percutaneous transluminal angioplasty for the treatment of critical limb ischemia: a 10-year experience. J Vasc Surg. 2005;41(3):423-435. https://doi.org/10.1016/j.jvs.2004.11.041
Jämsén TS, Manninen HI, Jaakkola PA, Matsi PJ. Long-term outcome of patients with claudication after balloon angioplasty of the femoropopliteal arteries. Radiology. 2002;225(2):345-352. https://doi.org/10.1148/radiol.2252011407
Kalbaugh CA, Taylor SM, Blackhurst DW, et al. One-year prospective quality-of-life outcomes in patients treated with angioplasty for symptomatic peripheral arterial disease. J Vasc Surg. 2006;44(2):296-303.
Taylor SM, Kalbaugh CA, Blackhurst DW, et al. Determinants of functional outcome after revascularization for critical limb ischemia: an analysis of 1000 consecutive vascular interventions. J Vasc Surg. 2006;44(4):747-756. https://doi.org/10.1016/j.jvs.2006.06.015
Kokov LS, Zelenov MA, Kalashnikov SV, et al. Endovascular treatment of occlusive-stenotic lesions of the femoral-popliteal segment arteries. In the guidelines: Vascular and intra-organ stenting. M.: Izdatel’skij Dom «Graal’». 2003. (In Russ.).
Baird RN, Bradley MD, Murphy KP. Tibioperoneal angioplasty and bypass. Acta Chir Belg. 2003;103(4):383-387. https://doi.org/10.1080/00015458.2003.11679448
Gargiulo M, Maioli F, Faggioli GL, et al. Kissing balloon technique for angioplasty of popliteal and tibio-peroneal arteries bifurcation. Eur J Vasc Endovasc Surg. 2008;36(2):197-202. https://doi.org/10.1016/j.ejvs.2008.01.031
Rigatelli G, Zanchetta M. Interventional treatment of noncoronary atherosclerotic pathologies: an update about what the cardiologists should know. Ital Heart J. 2004;5(2):99-113.
Teraa M, Conte MS, Moll FL, Verhaar MC. Critical Limb Ischemia: Current Trends and Future Directions. J Am Heart Assoc. 2016;5(2):e002938. https://doi.org/10.1161/JAHA.115.002938
Popplewell MA, Davies HOB, Narayanswami J, et al. A comparison of outcomes in patients with infrapopliteal disease randomised to vein bypass or plain balloon angioplasty in the Bypass vs. Angioplasty in Severe Ischaemia of the Leg (BASIL) Trial. Eur J Vasc Endovasc Surg. 2017;54:195-201.
TASC Steering Committee, Jaff MR, White CJ, et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the InterSociety Consensus for the Management of Peripheral Arterial Disease (TASC II). J Endovasc Ther. 2015;22:663-677.
Alekyan BG, Zakaryan NV, Pankov AS. The current state of endovascular treatment of atherosclerotic and diabetic lesions of the arteries of the lower extremities in the Russian Federation. Endovaskulyarnaya hirurgiya. 2016;3(4):5-12. (In Russ.).
Ahn J, Byeon J, Choi BG, et al. Stenting versus balloon angioplasty alone in patients with below-the-knee disease: A propensity score-matched analysis. PLoS One. 2021;16(6):e0251755. https://doi.org/10.1371/journal.pone.0251755
Rockley M, Yogendrakumar V, Rockley K, et al. Prolonged versus brief balloon inflation for arterial angioplasty. J Vasc Surg. 2018;68(3):e85-e86.
Haimivici H, ed. Haimovici’s Vascular Surgery. 5th ed. Oxford, UK: Blackwell Publishing Ltd. 2004. https://doi.org/10.1002/9781118481370
Kostanyan GM, Hramyh TP, Gajgiev TI, et al. X-ray endovascular interventions in lower limb ischemia in patients with diabetes mellitus: current opportunities and prospects. Pirogov Russian Journal of Surgery. 2022;(10):99-104. (In Russ.). https://doi.org/10.17116/hirurgia202210199
Katsanos K, Kitrou P, Spiliopoulos S, et al. Comparative effectiveness of plain balloon angioplasty, bare metal stents, drug-coated balloons, and drug-eluting stents for the treatment of infrapopliteal artery disease: systematic review and bayesian network meta-analysis of randomized controlled trials. J Endovasc Ther. 2016;23:851-863.
Katsanos K, Spiliopoulos S, Kitrou P, et al. Risk of death following application of paclitaxel-coated balloons and stents in the femoropopliteal artery of the leg: a systematic review and metaanalysis of randomized controlled trials. J Am Heart Assoc. 2018;7:e011245.
Katsanos K, Spiliopoulos S, Paraskevopoulos I, et al. Systematic review and meta-analysis of randomized controlled trials of paclitaxel-coated balloon angioplasty in the femoropopliteal arteries: role of paclitaxel dose and bioavailability. J Endovasc Ther. 2016;23:356-370.
Horwitz SB. Taxol (paclitaxel): mechanisms of action. Ann Oncol. 1994;5(Suppl 6):S3-S6.
Speck U, Cremers B, Kelsch B, et al. Do pharmacokinetics explain persistent restenosis inhibition by a single dose of paclitaxel? Circ Cardiovasc Interv. 2012;5:392-400.
Stolzenburg N, Breinl J, Bienek S, et al. Paclitaxel-coated balloons: investigation of drug transfer in healthy and atherosclerotic arteries—first experimental results in rabbits at low inflation pressure. Cardiovasc Drugs Ther. 2016;30:263-270.
Tzafriri AR, Vukmirovic N, Kolachalama VB, et al. Lesion complexity determines arterial drug distribution after local drug delivery. J Control Release. 2010;142:332-338.
Ouriel K, Veith FJ, Sasahara AA. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. N Engl J Med. 1998;338(16):1105-1111.
Kropman RH, Schrijver AM, Kelder JC, et al. Clinical outcome of acute leg ischaemia due to thrombosed popliteal artery aneurysm: systematic review of 895 cases. Eur J Vasc Endovasc Surg. 2010;39(4):452-457.
Limtungturakul S, Wongpraparut N, Pornratanarangsri S, et al. Early experience of catheter directed thrombolysis for acute limb ischemia of native vessels and bypass graft thrombosis in Thai patients. J Med Assoc Thai. 2011;94(1):S11-S18.
Schwarzwalder U, Zeller T. Debulking procedures: potential device specific indications. Tech Vase Interv Radiol. 2010;13:43-53. https://doi.org/10.1053/j.tvir.2009.10.006
Rastan A. Initial experience with directed laser atherectomy using the CLiRpath photoablation atherectomy system and bias sheath in superficial femoral artery lesions. J Endovasc Ther. 2007;14(3):365-373. https://doi.org/10.1583/06-2046.1
Tomey MI, Kini AS, Sharma SK. Current status of rotational atherectomy. JACC Cardiovasc Interv. 2014;7(4):345-353.
Gray WA, Garcia LA, Amin A, et al; JET Registry Investigators. JetStream Atherectomy System treatment of femoropopliteal arteries: results of the post-market JET Registry. Cardiovasc Revasc Med. 2018;19(5 pt A):506-511.
Shammas NW, Shammas GA, Banerjee S, et al. JetStream rotational and aspiration atherectomy in treating in-stent restenosis of the femoropopliteal arteries: results of the JETSTREAMISR feasibility study. J Endovasc Ther. 2016;23:339-346.
Shammas NW, Petruzzi N, Henao S, et al. JetStream Atherectomy for the Treatment of In-Stent Restenosis of the Femoropopliteal Segment: One-Year Results of the JET-ISR Study. J Endovasc Ther. 2021;28(1):107-116. https://doi.org/10.1177/1526602820951916
Shammas NW, Jones-Miller S, Shammas GA, et al. CRT200.14 JetStream atherectomy in treating femoropopliteal instent restenosis: meta-analysis of the JETSTREAM-ISR and JET-ISR trials [abstract]. JACC Cardiovasc Interv. 2020;13(4 suppl):S30. https://doi.org/10.1016/j.jcin.2020.01.089
Gandini R, Del Giudice C, Merolla S, et al. Treatment of chronic SFA in-stent occlusion with combined laser atherectomy and drug-eluting balloon angioplasty in patients with critical limb ischemia: a single-center, prospective, randomized study. J Endovasc Ther. 2013;20:805-814.
Kwon Y, Kim J, Won JH, et al. Atherectomy in Peripheral Artery Disease: Current and Future. Taehan Yongsang Uihakhoe Chi. 2021;82(3):551-561. https://doi.org/10.3348/jksr.2021.0036
Zeller T, Krankenberg H, Steinkamp H, et al. One-year outcome of percutaneous rotational atherectomy with aspiration in infrainguinal peripheral arterial occlusive disease: the multicenter pathway PVD trial. J Endovasc Ther. 2009;16(6):653-662. https://doi.org/10.1583/09-2826.1