Methods of optimizing the results of endovascular revascularization of infrainguinal arteries (literature review)

Abstract

With the development of advanced technologies, minimally invasive methods are becoming increasingly widespread in surgery, offering several advantages compared to traditional open surgery. In vascular surgery, endovascular revascularization methods are gaining increasing importance in the management of lower limb occlusive diseases. However, there are certain challenges that limit the effectiveness of endovascular revascularization and increase the likelihood of technical failure. One of the major challenges in endovascular revascularization of lower limb arteries is achieving re-entry into the vessel lumen during subintimal angioplasty. In certain cases, especially when there is severe atherosclerotic involvement of the vessel wall or calcification, the use of standard wire loop techniques may not always allow for re-entry into the true lumen of the vessel, and performing other surgical interventions may be limited or even impossible. Increasing the success rate of subintimal angioplasty will enhance the competitiveness of endovascular revascularization compared to open and hybrid reconstructive surgeries. Several techniques have been proposed to optimize the outcomes of endovascular revascularization, including the SAFARI technique, which combines antegrade and retrograde access for traversing complex occlusions. Re-entry devices equipped with specially curved needles at the catheter tip are used to direct the 0.014 inch wire into the true lumen of the vessel. Atherectomy devices with high-speed rotating blades driven by a motor are also employed to disrupt calcified plaques, creating a passage through heavily calcified occlusions that cannot be traversed by other means. These methods of optimizing the outcomes of endovascular revascularization can be used individually or in combination. We have analyzed the technical aspects of performing the mentioned procedures and their clinical outcomes based on literature sources. According to published data, the application of methods to optimize the outcomes of endovascular revascularization of infrainguinal arteries increases the success rate of these procedures to ≥90%. The widespread use of these methods is hindered by the high cost of re-entry and atherectomy devices. Accumulating our own experience will help improve the effectiveness of angioplasty in patients with chronic infrainguinal artery occlusions.

Keywords

• subintimal angioplasty; endovascular revascularization; stenting; critical limb ischemia.