Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492008000300010
Jornal Vascular Brasileiro
Review Article

Current status of infrapopliteal artery stenting in patients with critical limb ischemia

Estado atual do uso de stents na artéria infrapolítea em pacientes com isquemia crítica do membro

Marc Bosiers; Koen Deloose; Rodrigo Moreialvar; Jurgen Verbist; Patrick Peeters

Downloads: 0
Views: 429

Abstract

Due to the fear that early thrombosis and late luminal loss resulting from intimal hyperplasia might impede sustained patency of small-caliber arteries, such as those of the infrapopliteal bed, stent implantation in below-knee vessels remains controversial and is generally reserved for cases with a suboptimal outcome after percutaneous transluminal angioplasty (i.e. > 50% residual stenosis, flow-limiting dissection). Although evidence starts to build, favoring the use of stenting in the tibial area, results of well-conducted randomized controlled trials have to be awaited to change this strategy. Because of diameter similarities with coronary arteries, the first stents applied in the infrapopliteal vessels were all coronary devices. Once the feasibility of the stenting approach with these coronary products was shown, device manufacturers started to develop a dedicated infrapopliteal product range. To date, a broad spectrum of stent types has been used and investigated for the given indication. This article overviews the available literature and results of different balloon-expandable (bare metal, passive coated, drug eluting), self-expanding and absorbable stent types available for below-the-knee application and gives recommendations for future device technology advancements.

Keywords

Stents, ischemia, arteriosclerosis

Resumo

Devido ao receio de que a trombose precoce ou a estenose tardia por hiperplasia intimal possam impedir a manutenção da perviedade em vasos de pequeno calibre, o uso de stents pós-angioplastia no leito arterial infrapoplíteo permanece controverso e geralmente é reservado aos casos de resultado subótimo após angioplastia transluminal percutânea (isto é, estenose residual > 50% ou dissecção com limitação do fluxo). Apesar de evidências começarem a favorecer o uso de stents no segmento tibial, é necessário aguardar o resultado de ensaios controlados, randomizados e bem conduzidos para mudar esta estratégia. Sendo estes vasos infrapoplíteos de diâmetro similar às artérias coronárias, os primeiros stents usados neste segmento eram todos stents coronários. Uma vez que se mostrou exeqüível o uso destes stents, a indústria iniciou o desenvolvimento de uma linha de produtos específicos ao segmento infrapoplíteo. Atualmente uma gama de stents tem sido usada e investigada para este fim. Este artigo revê resultados disponíveis na literatura com diferentes stents expansíveis por balão (metal não-recoberto, revestimento passivo, eluição de fármacos), auto-expansíveis e absorvíveis disponíveis para o segmento infrapoplíteo e apresenta recomendações para os futuros avanços tecnológicos dos dispositivos.

Palavras-chave

Stents, isquemia, arteriosclerose

References

Norgren L, Hiatt WR, Dormandy JA. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(^sS):S5-67.

Dorros G, Jaff MR, Dorros AM, Mathiak LM, He T. Tibioperoneal (outflow lesion) angioplasty can be used as primary treatment in 235 patients with critical limb ischemia: five-year follow-up. Circulation. 2001;104:2057-62.

Hanna GP, Fujise K, Kjellgren O. Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: importance of aggressive interventional approach and role of transcutaneous oximetry. J Am Coll Cardiol. 1997;30:664-9.

Parsons RE, Suggs WD, Lee JJ, Sanchez LA, Lyon RT, Veith FJ. Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: do the results justify an attempt before bypass grafting?. J Vasc Surg. 1998;28:1066-71.

Ingle H, Nasim A, Bolia A. Subintimal angioplasty of isolated infragenicular vessels in lower limb ischemia: long-term results. J Endovasc Ther. 2002;9:411-6.

Adam DJ, Beard JD, Cleveland T. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366:1925-34.

Goy JJ, Urban P. Life and limb: bypass versus angioplasty in the ischaemic limb. Lancet. 2005;366:1905-6.

Bosiers M, Kallakuri S, Deloose K, Verbist J, Peeters P. Infragenicular angioplasty and stenting in the management of critical limb ischaemia: one year outcome following the use of the MULTI-LINK VISION stent. EuroIntervention. 2007;3:470-4.

Scheinert D, Ulrich M, Scheinert S. Comparison of sirolimus-eluting vs. bare-metal stents for the treatment of infrapopliteal obstructions. EuroIntervention. 2006;2:169-74.

Siablis D, Karnabatidis D, Katsanos K. Sirolimus-eluting versus bare stents after suboptimal infrapopliteal angioplasty for critical limb ischemia: enduring 1-year angiographic and clinical benefit. J Endovasc Ther. 2007;14:241-50.

Rand T, Basile A, Cejna M. PTA versus carbofilm-coated stents in infrapopliteal arteries: pilot study. Cardiovasc Intervent Radiol. 2006;29:29-38.

Duda S, Bosiers M, Lammer J. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial. J Endovasc Ther. 2006;13:701-10.

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. Am Coll Cardiol. 2004;44:2307-14.

Siablis D, Kraniotis P, Karnabatidis D, Kagadis GC, Katsanos K, Tsolakis J. Sirolimus-eluting versus bare stents for bailout after suboptimal infrapopliteal angioplasty for critical limb ischemia: 6-month angiographic results from a nonrandomized prospective single-center study. J Endovasc Ther. 2005;12:685-95.

Bosiers M, Deloose K, Verbist J, Peeters P. Percutaneous transluminal angioplasty for treatment of ''below-the-knee'' critical limb ischemia: early outcomes following the use of sirolimus-eluting stents. J Cardiovasc Surg (Torino). 2006;47:171-6.

Commeau P, Barragan P, Roquebert . Sirolimus for below the knee lesions: mid-term results of SiroBTK study. Catheter Cardiovasc Interv. 2006;68:793-8.

Feiring AJ, Wesolowski AA. Antegrade popliteal artery approach for the treatment of critical limb ischemia in patients with occluded superficial femoral arteries. Catheter Cardiovasc Interv. 2007;69:665-70.

Siablis D, Karnabatidis D, Katsanos K, Diamantopoulos A, Christeas N, Kagadis GC. Infrapopliteal application of paclitaxel-eluting stents for critical limb ischemia: midterm angiographic and clinical results. J Vasc Interv Radiol. 2007;18:1351-61.

Diener HC, Bogousslavsky J, Brass LM. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331-7.

Eisenstein EL, Anstrom KJ, Kong DF. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA. 2007;297:159-68.

Waksman R. Update on bioabsorbable stents: from bench to clinical. J Interv Cardiol. 2006;19:414-21.

Harper R. Drug-eluting stents coronary stents--a note of caution. Med J Aust. 2007;186:253-5.

Schwarzmaier-D'Assie A, Karnik R, Bonner G, Vavrik J, Slany J. Fracture of a drug-eluting stent in the tibioperoneal trunk following bifurcation stenting. J Endovasc Ther. 2007;14:106-9.

Scheinert D, Scheinert S, Sax J. Prevalence and clinical impact of stent fractures after femoropopliteal stenting. . .

Kickuth R, Keo H, Triller J, Ludwig K, Do DD. Initial clinical experience with the 4-F self-expanding XPERT stent system for infrapopliteal treatment of patients with severe claudication and critical limb ischemia. J Vasc Interv Radiol. 2007;18:703-8.

Romiti M, Albers M, Brochado-Neto FC, Durazzo AE, Pereira CA, De Luccia N. Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg. 2008;47:975-81.

Di Mario C, Griffiths H, Goktekin O. Drug-eluting bioabsorbable magnesium stent. J Interv Cardiol. 2004;17:391-5.

Peeters P, Bosiers M, Verbist J, Deloose K, Heublein B. Preliminary results after application of absorbable metal stents in patients with critical limb ischemia. J Endovasc Ther. 2005;12:1-5.

Bosiers M, Deloose K, Verbist J, Peeters P. Will absorbable metal stent technology change our practice?. J Cardiovasc Surg (Torino). 2006;47:393-7.

Bosiers M, Deloose K, Verbist J, Peeters P. First Clinical Application of Absorbable Metal Stents in the Treatment of Critical Limb Ischemia: 12-month results. Vasc Disease Management. 2005;2:86-91.

Allie D, Hebert C, Lirtzman M. Critical Limb ischemia: a global epidemic. A Critical analysis of current treatment unmasks the clinical and economic costs of CLI. uroIntervention. 2005;1:75-84.

5ddd64550e882522361da3e9 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections