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Recent Advances in Lower Limb Interventions & Peripheral BRS Technology

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Dr NN Khanna, New Delhi    06 January 2018

  1. Indications for stenting include: > Fontaine IIb claudication, nonhealing ulcer, limb salvage in cases of impending gangrene.
  2. Alternative technologies/devices for femoropopliteal artery intervention include covered stent, DES, cryoplasty, excimer laser angioplasty, atherectomy.
  3. Some trials involving different SFA endovascular therapies include RESILIENT, DURABILITY, ZILVER PTX, IN.PACT SFA, LEVANT 2, DEFINITIVE LE.
  4. 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.
  5. 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.
  6. 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.
  7. DEB efficacy has been proven in short (<9-10 cm) noncalcified 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.
  8. Newer percutaneous treatment options are associated with much lower procedural complications and good long-term outcomes.

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