The current state of endovascular treatment of below-the-knee arterial lesions in critical ischemic limbs

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  • 重症虚血肢における膝下動脈病変に対する血管内治療の現況
  • ジュウショウキョケツシ ニ オケル ヒザモト ドウミャク ビョウヘン ニ タイスル ケッカン ナイ チリョウ ノ ゲンキョウ

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Revascularization is essential to treat critical ischemic limbs (CLI). Most of patients with CLI have severe below-the-knee (BK) lesions which have to be reconstructed to establish the pulsating reflow to the pedal arteries. Endovascular treatment (EVT) is preferable to bypass surgery because most CLI patients have cardiovascular comorbidities. Most of BK lesions are diffuse, severely calcified and chronic totally occluded (CTO) which are so tough for EVT. However, the development of low profile devices and technical improvement such as echoguidance and bidirectional approach, can improve the initial success rates of EVT to greater than 90%. The limb salvage rates of EVT are also comparable to those of surgery although the primary patency of EVT is poorer than that of surgery. However, the frequent restenosis still remains one of major problems of EVT, which now investigated drug eluting stents and balloons may be able to overcome. EVT for BK lesions is a promising treatment of CLI.

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