Drug-coated balloon in peripheral artery disease
Highlights
- • Traditionally surgery was considered gold standard for lower extremity PAD, but there is significantly less morbidity and faster recovery times with endovascular therapies especially in patients with multiple medical comorbidities.
- • Major criticism of endovascular therapy has been the low long-term patency rate especially for infra-inguinal interventions and the evolution of drug-coated therapy is aimed at increasing the patency rates of endovascular technologies.
- • The drug-coated balloon is the new addition to this arena and consists of standard PTA catheter, excipient that helps release the drug rapidly as soon as it comes in contact with the vessel wall and the drug itself.
- • Drug coated balloon angioplasty results in significant reduction of binary restenosis, target lesion revascularization and improvement in primary patency rates.
- • Combining therapies such as atherectomy and DCB have theoretical advantages and appear attractive as a treatment strategy but remains to be studied.
Abstract
Peripheral artery disease (PAD) is highly prevalent but is often underdiagnosed and undertreated. Lower extremity PAD can often be life style limiting. Revascularizationin carefully selected lower extremity PAD patients improves symptoms and functional status. Surgical revascularization used to be the only available strategy, but in the recent years, endovascular strategies have gained popularity due to faster recovery times with low morbidity and mortality rates. Endovascular procedures have increased significantly in the United States in the past few years. That being said, higher restenosis rates and low long-term patency rates have been the limiting factors for this strategy. Drug eluting stents have been introduced to help with lowering restenosis, however lower extremity PAD involves long segment where the outcomes of stents are suboptimal. Also, the disease often crosses joint line that makes it less ideal for the stents. Drug-coated balloons (DCB) have been introduced to improve patency rates following endovascular intervention for lower extremity PAD. They have gained popularity among endovascular specialists due to its ease of use and the concept of “leave nothing behind”. This is a review of scientific evidence supporting DCB use in PAD.