Distal embolic protection for infrainguinal interventions: how to and when?

Distal embolization is a well-recognized complication during lower extremity revascularization procedures. Preliminary work has shown safety and feasibility of the use of embolic protection devices in this vascular territory. While many interventionalists believe that this technology offers a clear benefit for infrainguinal use based on the clinical safety data seen in other vascular beds, others believe that the exact role is poorly defined. All clinical experience to date has been with devices designed for other vascular territories and this has created a unique set of technical obstacles and potential risks. At present, clinical use is increasing despite a lack of data regarding which patients are at greatest risk for distal embolization, which anatomy is appropriate for the use of this technology, and which device, if any, is ideally suited for the infrainguinal arterial circulation. In addition, the clinical relevance and effect of distal embolization in the lower extremity remains poorly understood. Ultimately, more trial data may be necessary to substantiate the increased use of distal protection devices in infrainguinal interventions to justify the increase in cost, complexity, and potential risks associated with the use of this technology.