Algorithm of Femoropopliteal Endovascular Treatment
<i>Background and Objectives</i>: Indications for the endovascular treatment of femoropopliteal lesions have steadily increased over the past decade. Accordingly, the number of devices has also increased, but the choice of the best endovascular treatment remains to be defined. Many devic...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-09-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/9/1293 |
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| author | Maxime Dubosq Maxime Raux Bahaa Nasr Yann Gouëffic |
| author_facet | Maxime Dubosq Maxime Raux Bahaa Nasr Yann Gouëffic |
| author_sort | Maxime Dubosq |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Indications for the endovascular treatment of femoropopliteal lesions have steadily increased over the past decade. Accordingly, the number of devices has also increased, but the choice of the best endovascular treatment remains to be defined. Many devices are now available for physicians. However, in order to obtain a high success rate, it is necessary to respect an algorithm whose choice of device is only one step in the treatment. <i>Materials and Methods</i>: The first step is, therefore, to define the approach according to the lesion to be treated. Anterograde approaches (femoral, radial, or humeral) are distinguished from retrograde approaches depending on the patient’s anatomy and surgical history. Secondarily, the lesion will be crossed intraluminally or subintimally using a catheter or an angioplasty balloon. The third step corresponds to the preparation of the artery, which is essential before the implantation of the device. It has a crucial role in reducing the rate of restenosis. Several tools are available and are chosen according to the lesion requiring treatment (stenosis, occlusion). Among them, we find the angioplasty balloon, the atherectomy probes, or intravascular lithotripsy. Finally, the last step corresponds to the choice of the device to be implanted. This is also based on the nature of the lesion, which is considered short, up to 15 cm and complex beyond that. The choice of device will be between bare stents, covered stents, drug-coated balloons, and drug-eluting stents. Currently, drug-eluting stents appear to be the treatment of choice for short lesions, and active devices seem to be the preferred treatment for more complex lesions, although there is a lack of data. <i>Results</i>: In case of failure to cross the lesion, the retrograde approach is a safe and effective alternative. Balloon angioplasty currently remains the reference method for the preparation of the artery, the aim of which is to ensure the intraoperative technical success of the treatment (residual stenosis < 30%), to limit the risk of dissection and, finally, to limit the occurrence of restenosis. Concerning the treatment, the drug-eluting devices seem to present the best results, whether for simple or complex lesions. <i>Conclusions</i>: Endovascular treatment for femoropopliteal lesions needs to be considered upstream of the intervention in order to anticipate the treatment and the choice of devices for each stage. |
| first_indexed | 2024-03-09T23:12:56Z |
| format | Article |
| id | doaj.art-a680060dbec64f198be517a5b94885a0 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T23:12:56Z |
| publishDate | 2022-09-01 |
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| series | Medicina |
| spelling | doaj.art-a680060dbec64f198be517a5b94885a02023-11-23T17:41:09ZengMDPI AGMedicina1010-660X1648-91442022-09-01589129310.3390/medicina58091293Algorithm of Femoropopliteal Endovascular TreatmentMaxime Dubosq0Maxime Raux1Bahaa Nasr2Yann Gouëffic3Department of Vascular and Endovascular Surgery, Institut Cœur-Poumon, 59000 Lille, FranceDepartment of Vascular and Endovascular Surgery, Groupe hospitalier Paris St Joseph, 75014 Paris, FranceDepartment of Vascular and Endovascular Surgery, Brest University Hospital, 29200 Brest, FranceDepartment of Vascular and Endovascular Surgery, Groupe hospitalier Paris St Joseph, 75014 Paris, France<i>Background and Objectives</i>: Indications for the endovascular treatment of femoropopliteal lesions have steadily increased over the past decade. Accordingly, the number of devices has also increased, but the choice of the best endovascular treatment remains to be defined. Many devices are now available for physicians. However, in order to obtain a high success rate, it is necessary to respect an algorithm whose choice of device is only one step in the treatment. <i>Materials and Methods</i>: The first step is, therefore, to define the approach according to the lesion to be treated. Anterograde approaches (femoral, radial, or humeral) are distinguished from retrograde approaches depending on the patient’s anatomy and surgical history. Secondarily, the lesion will be crossed intraluminally or subintimally using a catheter or an angioplasty balloon. The third step corresponds to the preparation of the artery, which is essential before the implantation of the device. It has a crucial role in reducing the rate of restenosis. Several tools are available and are chosen according to the lesion requiring treatment (stenosis, occlusion). Among them, we find the angioplasty balloon, the atherectomy probes, or intravascular lithotripsy. Finally, the last step corresponds to the choice of the device to be implanted. This is also based on the nature of the lesion, which is considered short, up to 15 cm and complex beyond that. The choice of device will be between bare stents, covered stents, drug-coated balloons, and drug-eluting stents. Currently, drug-eluting stents appear to be the treatment of choice for short lesions, and active devices seem to be the preferred treatment for more complex lesions, although there is a lack of data. <i>Results</i>: In case of failure to cross the lesion, the retrograde approach is a safe and effective alternative. Balloon angioplasty currently remains the reference method for the preparation of the artery, the aim of which is to ensure the intraoperative technical success of the treatment (residual stenosis < 30%), to limit the risk of dissection and, finally, to limit the occurrence of restenosis. Concerning the treatment, the drug-eluting devices seem to present the best results, whether for simple or complex lesions. <i>Conclusions</i>: Endovascular treatment for femoropopliteal lesions needs to be considered upstream of the intervention in order to anticipate the treatment and the choice of devices for each stage.https://www.mdpi.com/1648-9144/58/9/1293peripheral arterial diseaseendovascular procedurefemoropopliteal axisbare metal stentdrug-eluting stentdrug-coated balloon |
| spellingShingle | Maxime Dubosq Maxime Raux Bahaa Nasr Yann Gouëffic Algorithm of Femoropopliteal Endovascular Treatment Medicina peripheral arterial disease endovascular procedure femoropopliteal axis bare metal stent drug-eluting stent drug-coated balloon |
| title | Algorithm of Femoropopliteal Endovascular Treatment |
| title_full | Algorithm of Femoropopliteal Endovascular Treatment |
| title_fullStr | Algorithm of Femoropopliteal Endovascular Treatment |
| title_full_unstemmed | Algorithm of Femoropopliteal Endovascular Treatment |
| title_short | Algorithm of Femoropopliteal Endovascular Treatment |
| title_sort | algorithm of femoropopliteal endovascular treatment |
| topic | peripheral arterial disease endovascular procedure femoropopliteal axis bare metal stent drug-eluting stent drug-coated balloon |
| url | https://www.mdpi.com/1648-9144/58/9/1293 |
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