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Review
. 2024 Jan 29;3(3Part A):101268.
doi: 10.1016/j.jscai.2023.101268. eCollection 2024 Mar.

Surgical and Endovascular Therapies for Below-the-Knee Peripheral Arterial Disease: A Contemporary Review

Robert S Zilinyi  1 , Marissa Alsaloum  2 , Daniel J Snyder  2 , Aishwarya Raja  2 , Ari J Mintz  1 , Sanjum S Sethi  1 , Danielle Bajakian  3 , Sahil A Parikh  1
Affiliations
Review

Surgical and Endovascular Therapies for Below-the-Knee Peripheral Arterial Disease: A Contemporary Review

Robert S Zilinyi et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Peripheral arterial disease (PAD) represents one of the most prevalent cardiovascular disease processes and carries a high burden of morbidity and mortality. Patients with chronic limb-threatening ischemia (CLTI), the most severe manifestation of PAD, have the highest rates of cardiovascular morbidity and mortality of the overall PAD population. Patients with below-the-knee (BTK) PAD have an increased propensity toward CLTI due to small-vessel caliber and the frequently comorbid conditions of end-stage renal disease and diabetes mellitus, which tend to affect small artery beds preferentially. For those with BTK PAD with CLTI, the standard of care is revascularization. Early revascularization was performed using surgical bypass. However, endovascular techniques, starting with percutaneous transluminal angioplasty and expanding to the modern armamentarium of adjunctive devices and therapies, have become standard of care for most patients with CLTI due to BTK PAD. In this review, we will discuss the modern surgical and endovascular approaches to revascularization, as well as devices that are currently in development or preapproval study for the treatment of BTK PAD.

Keywords: below-the-knee; chronic limb-threatening ischemia; peripheral artery disease.

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Figures

Central Illustration
Central Illustration
Algorithm for the management of BTK PAD. BTK, below-the-knee; BVS, bioresorbable vascular scaffold; CTO, chronic total occlusion; DCB, drug-coated balloon; DES, drug-eluting stent; DRS, drug-eluting bioresorbable scaffold; GSV, greater saphenous vein; IVL, intravascular lithotripsy; IVUS, intravascular ultrasound; PAD, peripheral arterial disease; PTA, percutaneous transluminal angioplasty.
See this image and copyright information in PMC

References

    1. Mustapha J.A., Katzen B.T., Neville R.F., et al. Disease burden and clinical outcomes following initial diagnosis of critical limb ischemia in the medicare population. JACC Cardiovasc Interv. 2018;11(10):1011–1012. - PubMed
    1. Norgren L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes F.G.R., TASC II Working group Inter-society consensus for the management of peripheral arterial disease (TASC II) J Vasc Surg. 2007;45(1 Supplement):S5–S67. - PubMed
    1. Gerhard-Herman M.D., Gornik H.L., Barrett C., et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2017;135(12):e686–e725. - PMC - PubMed
    1. Vartanian S.M., Conte M.S. Surgical intervention for peripheral arterial disease. Circ Res. 2015;116(9):1614–1628. - PubMed
    1. Faries P.L., Logerfo F.W., Arora S., et al. A comparative study of alternative conduits for lower extremity revascularization: all-autogenous conduit versus prosthetic grafts. J Vasc Surg. 2000;32(6):1080–1090. - PubMed

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