Interventions in Below-the-Knee Lesions in Critical Limb Ischemia

For patients with intermittent claudication (IC), approximately 20% will have progressive symptoms and 1-2% will develop critical limb ischemia (CLI) within 5 years and a 1-year mortality rate of about 20% in several series. This chapter discusses the following endovascular techniques that have been used for recanalization of the infrapopliteal arteries: balloon angioplasty; drug-eluting balloon angioplasty; cryotherapy; bare metal and drug-eluting stent placement; and adjunctive interventions. Specialized cryoplasty balloon catheters are inflated not with the standard mixture of saline solution and contrast medium but rather with nitrous oxide. Stent placement for infrapopliteal disease has gained progressive attention. The proven efficacy of drug-coated stents in the treatment of coronary artery disease gave rise to the notion that they might have a better patency compared to bare metal stents (BMS) in small infrapopliteal vessels. Atherectomy devices are designed to debulk and remove atherosclerotic plaque by cutting, pulverizing, or shaving with catheter-deliverable blades.