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World J Cardiol. Jan 26, 2019; 11(1): 13-23
Published online Jan 26, 2019. doi: 10.4330/wjc.v11.i1.13
Current evidence of drug-elution therapy for infrapopliteal arterial disease
Stavros Spiliopoulos, Nikiforos Vasiniotis Kamarinos, Elias Brountzos
Stavros Spiliopoulos, Nikiforos Vasiniotis Kamarinos, Elias Brountzos, 2nd Radiology Department, Interventional Radiology Unit, University of Athens, Attikon University General Hospital, Athens 12461, Greece
Author contributions: Spiliopoulos S conceived the review and made critical revisions to its content; Vasiniotis Kamarinos N drafted the manuscript and made critical revisions to its content; Brountzos E drafted the manuscript and made critical revisions to its content; all authors approved the final version of the article.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Stavros Spiliopoulos, MD, PhD, Assistant Professor, 2nd Radiology Department, Interventional Radiology Unit, Attikon University Hospital, University of Athens, Attikon University General Hospital, Athens 12461, Greece, Athens 12461, Greece. stavspiliop@med.uoa.gr
Telephone: +30-210-5831832
Received: July 27, 2018
Peer-review started: July 30, 2018
First decision: October 5, 2018
Revised: October 23, 2018
Accepted: January 1, 2019
Article in press: January 1, 2019
Published online: January 26, 2019
Processing time: 183 Days and 1 Hours
Abstract

New and sophisticated endovascular devices, such as drug-eluting stents (DES) and drug-coated balloons (DCB), provide targeted drug delivery to affected vessels. The invention of these devices has made it possible to address the reparative cascade of arterial wall injury following balloon angioplasty that results in restenosis. DESs were first used for the treatment of infrapopliteal lesions almost 20 years ago. More recently, however, DCB technology is being investigated to improve outcomes of endovascular below-the-knee arterial procedures, avoiding the need for a metallic scaffold. Today, level IA evidence supports the use of infrapopliteal DES for short to medium length lesions, although robust evidence that justifies the use of DCBs in this anatomical area is missing. This review summarizes and discusses all available data on infrapopliteal drug-elution devices and highlights the most promising future perspectives.

Keywords: Drug-elution therapy; Infrapopliteal arterial disease; Current evidence; Drug-coated balloons; Drug-eluting stents

Core tip: Currently available level IA evidence justifies the use of infrapopliteal drug-eluting stents for short to medium length lesions in selected patients with specific anatomical criteria. The role of infrapopliteal drug-coated balloons remains to be determined.