Zilinyi Robert S, Alsaloum Marissa, Snyder Daniel J, Raja Aishwarya, Mintz Ari J, Sethi Sanjum S, Bajakian Danielle, Parikh Sahil A
Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York.
Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York.
J Soc Cardiovasc Angiogr Interv. 2024 Jan 29;3(3Part A):101268. doi: 10.1016/j.jscai.2023.101268. eCollection 2024 Mar.
Peripheral arterial disease (PAD) represents one of the most prevalent cardiovascular disease processes and carries a high burden of morbidity and mortality. Patients with chronic limb-threatening ischemia (CLTI), the most severe manifestation of PAD, have the highest rates of cardiovascular morbidity and mortality of the overall PAD population. Patients with below-the-knee (BTK) PAD have an increased propensity toward CLTI due to small-vessel caliber and the frequently comorbid conditions of end-stage renal disease and diabetes mellitus, which tend to affect small artery beds preferentially. For those with BTK PAD with CLTI, the standard of care is revascularization. Early revascularization was performed using surgical bypass. However, endovascular techniques, starting with percutaneous transluminal angioplasty and expanding to the modern armamentarium of adjunctive devices and therapies, have become standard of care for most patients with CLTI due to BTK PAD. In this review, we will discuss the modern surgical and endovascular approaches to revascularization, as well as devices that are currently in development or preapproval study for the treatment of BTK PAD.
外周动脉疾病（PAD）是最常见的心血管疾病进程之一，具有很高的发病和死亡负担。患有慢性肢体威胁性缺血（CLTI）的患者是PAD最严重的表现形式，在整个PAD人群中，其心血管发病率和死亡率最高。膝下（BTK）PAD患者由于血管管径小以及终末期肾病和糖尿病等常见合并症，更容易发展为CLTI，这些合并症往往优先影响小动脉床。对于患有BTK PAD并伴有CLTI的患者，治疗标准是血运重建。早期血运重建采用外科旁路手术。然而，从经皮腔内血管成形术开始，到扩展到现代辅助设备和治疗手段的血管内技术，由于BTK PAD导致的CLTI，已成为大多数患者的治疗标准。在本综述中，我们将讨论血运重建的现代外科和血管内方法，以及目前正在开发或处于批准前研究阶段用于治疗BTK PAD的设备。
