Advances in below-the-knee endovascular treatment of critical limb ischemia

The patients with critical limb ischemia usually has atherosclerosis disease below the knee. The endovascular therapy below the knee is more difficult and less effective compared with iliac-femoral and femoral-popliteal vascular. The intraluminal devices have been improved much now, such as the invention of drug eluting stent (DES) and drug eluting balloon (DEB), which has improved the results of intraluminal therapy in femoral-popliteal artery greatly. However, the effect of endovascular therapy with the drug-eluting devices below the knee is controversial. We review a lot of the clinical trails about this issue and found that percutaneous transluminal angioplasty (PTA) with bailing-out bare metal stent (BMS) is still the primary strategy and PTA with DES may gain better effect when treating short lesions. Key words: Ischemia/SU; Extremities/PA; Drug-eluting stents; Balloon dilatation; Review