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Objective: To evaluate the role of drug eluting stents in below knee revascularization in patients with critical limb ischemia who are deemed high risk candidates for an open revascularization procedure.
Methods: We retrospectively reviewed 13 consecutive high-risk patients (15 limbs) who underwent drug eluting stent placement over a period of 18 months. Standard percutaneous techniques were used for stent placement. Outcomes were measured in terms of patency, limb salvage and relief of symptoms.
Results: Patient characteristics were as shown below in table 1. 10 of 13 patients were deemed very high risk for open revascularization due to debilitating medical conditions. 3 of 13 had a threatened distal bypass and were at higher risk due to difficult anatomy. The lesions included 3 below knee popliteal, 4 tibioperoneal trunk, 2 anterior tibial, 3 peroneal, 1 posterior tibial and 3 below knee distal bypass stenosis. Simultaneous proximal interventions were performed during 26.6% of the procedures. Mean follow up was 111 days (14-329 days). Pain relief was observed in 83.3%. Limb survival rate was 85.7%. The primary patency rate was 86.2% and secondary patency rate was 93.1%. Two patients had minor complications (one groin hematoma and one puncture site pseudo aneurysm)
Conclusions: Use of below the knee drug eluting stents is a safe and effective method for treatment of critical limb ischemia in high-risk surgical patients. Short term follow up demonstrates favorable clinical outcomes. Further studies to determine medium and long term outcomes are warranted.
Table 1. Patient characteristics

Age	79.6 ± 10.8
Sex (M:F)	9:4
Hypertension	92.3%
Diabetes	53.85%
Hyperlipidemia	69.2%
Coronary artery disease	38.4%
Chronic renal insufficiency	46.1%
Smoking	61.5%
ASA Class	3.3 ± 0.6
Rutherford Category	4.6 ± 0.8