When is embolic protection needed in lower extremity interventions and how should it be done.

Distal embolization (DE) during lower extremity arterial intervention is a potentially devastating complication which could lead to limb loss. The use of a distal embolic protection device (EP) may prevent significant DE during intervention. Studies investigating the incidence and impact of DE suggest that it is a rare event with low impact on clinical outcomes. The use of EP during peripheral interventions has only been studied in uncontrolled small series with no comparison to unprotected interventions. In spite of the absence of good quality studies, there may be situations where EP is helpful. These situations may be when lesions or devices are particularly prone to produce emboli. The EP device may produce its own serious complications which must be considered prior to their use. In addition these devices are fairly expensive, a factor that needs to be considered when deciding to employ EP. A simple direct comparison of EP vs. no EP during lower extremity intervention could answer many clinical questions surrounding this controversy.