From the Guidelines
The treatment for Peripheral Arterial Disease (PAD) using angioplasty involves the use of percutaneous transluminal angioplasty (PTA) balloon catheter with a specialized coating or medication on its surface, such as a drug-coated balloon (DCB), to deliver antiproliferative medications directly to the vessel wall during angioplasty. This approach is supported by recent guidelines, including the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1. The use of DCB has been shown to reduce the risk of restenosis and improve outcomes in patients with PAD.
Key Considerations
- The most common type of DCB contains paclitaxel or sirolimus coated on the balloon surface, which is released when the balloon is inflated against the vessel wall.
- Standard dosing for paclitaxel-coated balloons is 2-3.5 μg/mm² of balloon surface area, with drug delivery occurring within 30-60 seconds of balloon inflation.
- These devices are particularly useful for peripheral arterial disease, in-stent restenosis, and small vessel disease where traditional stenting may be less desirable.
- The medication continues working locally for weeks after the procedure, while the balloon itself is removed, leaving no permanent implant behind.
Patient Selection
The decision to perform angioplasty in patients with PAD should be individualized, taking into account the patient's specific needs and the expertise of the vascular specialists 1. Patients with foot ulcers in diabetes and peripheral artery disease should be managed in centers able to offer both open and endovascular revascularization approaches. The selection of technique should be based on factors such as the length of lesion, availability of autogenous venous conduit, and patient co-morbidity. Revascularization interventions should be avoided in patients in whom the risk-benefit ratio for the probability of success is unfavorable 1.
From the Research
Treatment for Peripheral Arterial Disease (PAD) using Angioplasty
- The treatment for PAD using angioplasty involves the use of closure devices to minimize complications at the access site 2, 3.
- Studies have shown that the use of closure devices, such as Angioseal, can reduce the risk of local complications, including hematoma and arteriovenous fistula formation 4, 2.
- However, the effectiveness of closure devices in patients with PAD undergoing angioplasty is still being researched, and more studies are needed to determine the best approach 3, 5.
- Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is commonly used in patients with PAD after angioplasty to prevent restenosis and major adverse limb events (MALE) 5, 6.
- Research has also investigated the impact of high on-treatment platelet reactivity after angioplasty in patients with critical limb ischemia, and found that it is frequent and associated with bleeding, but not with MALE or major adverse cardiac and cerebrovascular events (MACCE) 5.
- The use of combination antiplatelet therapy, such as clopidogrel and aspirin, has been shown to reduce platelet activation and platelet-derived growth factor (PDGF) levels, but its effect on smooth muscle cell proliferation and restenosis is still unclear 6.