Journal of Vascular and Endovascular Therapy

Description

Peripheral Arterial Disease (PAD) is a prevalent cardiovascular condition associated with signi icant morbidity and mortality, particularly in patients with Chronic Limb-Threatening Ischemia (CLTI). Among individuals with PAD, those with Below-The-Knee (BTK) involvement face heightened risks of CLTI due to factors such as small-vessel caliber and comorbid conditions like endstage renal disease and diabetes mellitus. Historically, surgical bypass was the primary treatment approach for revascularization in patients with BTK PAD and CLTI.

Surgical revascularization

However, advancements in endovascular techniques have revolutionized the management of this population. Percutaneous Transluminal Angioplasty (PTA) marked the initial shi t towards minimally invasive interventions, which has since been supplemented by a diverse array of adjunctive devices and therapies. In this comprehensive review, we explore the modern landscape of revascularization strategies for BTK PAD. We delve into the evolution of both surgical and endovascular approaches, highlighting their respective advantages, limitations, and clinical outcomes. Additionally, we discuss emerging devices and therapies that hold promise for further improving treatment efficacy and patient outcomes. Surgical revascularization techniques, such as bypass gra ting, remain essential in certain cases, particularly when anatomical considerations or patient factors preclude endovascular intervention. However, the widespread adoption of endovascular approaches re lects their favorable safety pro ile, shorter recovery times, and comparable efficacy in many patient populations. Furthermore, we examine the ongoing development of novel devices and therapies aimed at addressing speci ic challenges associated with BTK PAD revascularization. From drug-eluting balloons to bioresorbable stents, these innovations hold the potential to enhance vessel patency, reduce restenosis rates, and improve long-term outcomes for patients with CLTI. By synthesizing current evidence and exploring future directions in the field, this review aims to provide clinicians with a comprehensive understanding of the evolving landscape of BTK PAD revascularization. Ultimately, by staying abreast of advancements in technology and treatment strategies, healthcare providers can optimize care delivery and improve outcomes for individuals with this debilitating condition. As the field of vascular intervention continues to evolve, several key trends and considerations are shaping the management of BTK PAD. One notable trend is the increasing utilization of minimally invasive endovascular techniques as the first-line approach for revascularization.

Patient care

This shift reflects advancements in catheter-based technologies, including the development of specialized devices such as atherectomy systems, drug-coated balloons, and drugeluting stents, which offer targeted treatment options with reduced procedural morbidity. Moreover, the concept of a hybrid revascularization approach, combining elements of both surgical and endovascular techniques, has gained traction in the management of complex BTK lesions. Hybrid procedures allow for tailored treatment strategies that leverage the strengths of each modality, such as utilizing endovascular interventions for vessel preparation followed by open surgical bypass in select cases. In addition to technological innovations, a growing emphasis on multidisciplinary collaboration and patientcentered care is shaping the landscape of BTK PAD management. Multidisciplinary teams comprising vascular surgeons, interventional radiologists, podiatrists, wound care specialists, and other healthcare professionals work collaboratively to optimize patient outcomes through comprehensive assessment, individualized treatment planning, and coordinated postoperative care. Looking ahead, ongoing research efforts are focused on further re ining revascularization techniques, enhancing device performance, and investigating novel therapeutic targets to address the complex pathophysiology of BTK PAD. By embracing innovation and adopting a holistic approach to patient care, clinicians can continue to improve treatment outcomes and quality of life for individuals living with this challenging condition.