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Drug Eluting Stents for Below Knee Revascularization in High-Risk Patients with Critical Limb Ischemia
Sharvil U. Sheth, MD1, Gregory T. Simonian, MD2, Massimo M. Napolitano, MD2, Michael J. Wilderman, MD2.
1University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ, USA, 2Hackensack University Medical Center, Hackensack, NJ, USA.

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
Age79.6 ± 10.8
Sex (M:F)9:4
Hypertension92.3%
Diabetes53.85%
Hyperlipidemia69.2%
Coronary artery disease38.4%
Chronic renal insufficiency46.1%
Smoking61.5%
ASA Class3.3 ± 0.6
Rutherford Category4.6 ± 0.8


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