TY - CHAP
T1 - Tibial and Pedal Plantar Interventions in Patients with Critical Limb Ischemia
AU - Prasad, Anand
AU - Hughston, Haley
N1 - Publisher Copyright:
© 2019 by JohnWiley and Sons Ltd.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - The most morbid form of peripheral arterial disease (PAD) remains critical limb ischemia (CLI) associated with rest pain, gangrene or limb loss. This chapter reviews the basic epidemiology of distal tibial and forefoot disease, outlines the indications for percutaneous therapy of this vascular territory, and explores procedural considerations for modern distal extremity endovascular interventions. Patients with history and physical exam findings concerning for CLI should generally have non-invasive testing to establish a diagnosis. The ankle-brachial index (ABI) is a simple yet powerful tool and usually the first test of choice to detect PAD. Contralateral femoral access remains the most common approach to treat infrainguinal PAD, but may have limitations when trying to treat infrapopliteal lesions. To address the limitations of percutaneous transluminal angioplasty (PTA), stenting has been employed to treat flow-limiting dissections or persistent restenosis. To combat the risk of restenosis, antineoproliferative therapy has been explored in both drug-eluting stents (DESs) and drug-eluting balloons (DEBs).
AB - The most morbid form of peripheral arterial disease (PAD) remains critical limb ischemia (CLI) associated with rest pain, gangrene or limb loss. This chapter reviews the basic epidemiology of distal tibial and forefoot disease, outlines the indications for percutaneous therapy of this vascular territory, and explores procedural considerations for modern distal extremity endovascular interventions. Patients with history and physical exam findings concerning for CLI should generally have non-invasive testing to establish a diagnosis. The ankle-brachial index (ABI) is a simple yet powerful tool and usually the first test of choice to detect PAD. Contralateral femoral access remains the most common approach to treat infrainguinal PAD, but may have limitations when trying to treat infrapopliteal lesions. To address the limitations of percutaneous transluminal angioplasty (PTA), stenting has been employed to treat flow-limiting dissections or persistent restenosis. To combat the risk of restenosis, antineoproliferative therapy has been explored in both drug-eluting stents (DESs) and drug-eluting balloons (DEBs).
KW - ankle-brachial index
KW - contralateral femoral access
KW - critical limb ischemia
KW - distal extremity endovascular interventions
KW - drug-eluting balloons
KW - drug-eluting stents
KW - percutaneous therapy
KW - percutaneous transluminal angioplasty
KW - peripheral arterial disease
UR - http://www.scopus.com/inward/record.url?scp=85135973955&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85135973955&partnerID=8YFLogxK
U2 - 10.1002/9781119283539.ch16
DO - 10.1002/9781119283539.ch16
M3 - Chapter
AN - SCOPUS:85135973955
SN - 9781119283492
SP - 183
EP - 206
BT - Endovascular Interventions
PB - wiley
ER -