Below-the-knee (BTK) artery disease is a major pathological basis for chronic limb-threatening ischemia (CLTI). In recent years, endovascular therapy has progressively emerged as a significant approach for the treatment of BTK arterial disease, with notable advancements achieved in treatment strategies, vascular preparation devices, and related techniques. The treatment strategy has evolved from “the Global Vascular Guidelines (GVG)” and “the International Working Group on the Diabetic Foot (IWGDF), the European Society for Vascular Surgery (ESVS), and the Society for Vascular Surgery (SVS) guidelines on peripheral artery disease in people with diabetes and a foot ulcer” to the “Woundosome” concept. This framework emphasizes “wound perfusion improvement” as the ultimate goal. In terms of vessel preparation devices, paclitaxel-coated balloons have demonstrated advantages in patency and limb salvage for complex lesions, while sirolimus-coated balloons show potential for a superior safety profile. Bioresorbable scaffolds offer a novel “support-then-absorb” solution. Technically, vascular preparation devices (e.g., shockwave balloon) effectively manage severe calcification, and deep venous arterialization provides a last resort for limb salvage in “no-option” patients. Future developments in this field will rely on generating higher-level clinical evidence and constructing personalized treatment pathways tailored to patient characteristics and available medical resources, aiming to continuously improve limb salvage rate and quality of life for CLTI patients.
ObjectiveTo evaluate the safety and efficiency of SilverHawk plaque excision in treatment of sympto-matic infrapopliteal arterial occlusive disease (IPAD).
MethodsThe clinical and follow-up data of 54 consecutive patients with IPAD underwent endovascular treatment from 2011 to 2013 in this hospital were analyzed retrospectively. There were 29 males and 25 females. The age was (65.8±4.5) years, the period was (25.1±3.3) months. All the patients were Fontaine gradeⅡb-Ⅳ. The patients were divided into plaque excision group (n=9) and angioplasty group (n=45) according to the treatment method. The rates of technical success, perioperative complications, limb salvage and reintervention were observed between two groups.
Results①There were no significant differences in the gender, age, complications, ankle brachial index (ABI), outflow tract score, lesion length, and other clinical data between the 2 groups (P > 0.05).②The technical success rate had no significant difference between the plaque excision group and the angioplasty group[100% (9/9) versus 86.7% (39/45), P=0.574]. Six cases were failed because the guide wire could not pass through the diseased segment in 4 cases and there were 2 cases of serious residual stenosis in the angioplasty group.③There was no significant difference in the incidence of vascular complications between the 2 groups[11.1% (1/9) versus 11.1% (5/45), P=1.000].④The follow-up results:One case was received the carotid endarterectomy on 4 months after operation because of severe carotid artery stenosis, the lower limbs had no new onset of symptoms in the plaque excision group. One patient due to myocardial infarction was death on 3 months after operation, 2 patients due to pulmonary infection and heart failure were death on 4 months and 5 months after operation respectively in the angioplasty group. The limb salvage rates and reintervention rates on 6 months and 12 months after operation had no significant differences between the 2 groups (P> 0.05). The ABI and ABI average improvement also had no significant significances between the 2 groups (P > 0.05).
ConclusionPlaque excision is a safe and acceptable method to treat symptomatic IPAD, and its efficacy is better than angioplasty.
