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Recent advances in lower limb interventions and peripheral BRS technology

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Dr NN Khanna, New Delhi    02 December 2017

The SFA is a challenging artery to treat. Key developments in SFA intervention range from PTA atherectomy stent stent grafts to drug eluting stents and drug coated balloons. Indications for stenting include Fontaine II b claudication non healing ulcer limb salvage in cases of impending gangrene Alternative technologies devices for femoropopliteal artery intervention include covered stent DES Cryoplasty Excimer laser angioplasty atherectomy. Some trials involving different SFA endovascular therapies include RESILIENT DURABILITY ZILVER PTX IN.PACT SFA LEVANT 2 DEFINITIVE LE. Supera Stent has interwoven nitinol design is self expanding has high radial force and flexibility and can be used for calcified SFA lesions. Stem cell therapy is an emerging treatment modality for management of CLI in cases where revascularization is not possible. Lithoplasty for treatment of calcified SFA popliteal disease was studied in DISRUPT PAD trial. Potential benefits of BRS include absence of rigid metallic cage late lumen enlargement and restoration of vasomotor tone. Limitations of first generation BRS include lower modulus leading to higher recoil lower yield strength and lower tensile strength leading to increased susceptibility to fractures. Next generation BRS is designed to improve on all these aspects with reduced strut thickness. DEB efficacy has been proven in short 9 10 cm non calcified de novo lesions. DEB could be the first line strategy for TASC A B and C de novo lesions. For long lesions the combination atherectomy DEB could be a good option. Newer percutaneous treatment options are associated with much lower procedural complications and good long term outcomes.

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