Percutaneous Treatment of Peripheral Artery Disease

Percutaneous transluminal angioplasty is a minimally invasive therapy for the treatment of patients with peripheral artery disease who suffer from intermittent claudication or critical limb ischemia. The main advantages of the endovascular approach are a low complication rate ranging between 0.5% and 4%, a high technical success rate approaching 90% even in long occlusions, and an acceptable clinical outcome.1,2 Traditionally, percutaneous transluminal angioplasty (PTA) has been the standard for revascularization in aortoiliac, femoropopliteal, and below-the-knee arteries,1 and in many interventional centers, PTA still is the first and most frequently used methodology. However, high rates of failure resulting from an unacceptable incidence of restenosis, particularly in long and complex disease, are the main limitations of PTA.3Modern bare metal stents (BMS), nitinol self-expanding stents, and cobalt-chromium balloon-expanding stents improved the durability of endovascular interventions, particularly in certain lower-limb indications. Advantages of self-expanding nitinol stents include acceptable radial strength combined with shape-memory characteristics, crush recoverability, and reduced foreshortening, which allows precise placement. Self-expanding nitinol stents are used mainly for external iliac and femoropopliteal indications but have its limitation in ostial common iliac artery lesions. Advantages of cobalt-chromium balloon-expanding stents are high radial strength, specifically for ostial iliac lesions with reduced strut thickness, allowing smaller introducer sizes. These properties of both stents types were expected to improve patency rates compared with PTA and earlier types of stents.4,5 However, the main obstacle of these BMS remains exaggerated neointimal hyperplasia, leading to in-stent restenosis in 25% to 50% within 12 to 24 months, depending on the location of implantation.6,7New developments over the last several years include drug-eluting balloons (DEBs), new types of stents such as drug-eluting stents (DES) and covered stent grafts, and novel atherectomy systems. These are designed to reduce restenosis and …