Anecdotal Vs. Evidence-Based, Off Label Use of Drug Eluting Stents for Infrapopliteal Disease:Abusus Non Tollit Usum (Misuse Does Not Nullify Proper Use)

摘要

As the rates of adverse events associated with infrapopliteal balloon angioplasty, atherectomy, and stenting have dropped and relative success rates have increased in recent years, the desire to offer endovascular treatment to patients with limb threatening ischemia and disabling claudication as an alternative to distal bypasses has become widespread. Occlusive disease of the tibial vessels, once felt to be optimally treated with operative bypass only is now increasingly being treated percutane-ously [1-6]. Nevertheless, results of operative arterial reconstruction have also considerably improved. Excellent outcomes following bypass grafting with vein graft to the pedal vessels have been demonstrated, with morbidity, mortality, and long-term patency comparable to that of more proximal bypasses. Within the context of a changing paradigm, it is an appropriate time to examine and potentially redefine the role of both endovascular and open surgical intervention for patients with infrage-niculate arterial occlusive disease.