Current evidence of drug-elution therapy for infrapopliteal arterial disease

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.