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Revascularization Strategies in Peripheral Artery Disease and Chronic Limb-Threatening Ischemia: Current Standards and Future Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: 5 June 2025 | Viewed by 2007

Special Issue Editors

Dr. Constantijn E.V.B. Hazenberg

E-Mail Website
Guest Editor
Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
Interests: peripheral artery disease (PAD); aortic pathology; endovascular interventions
Special Issues, Collections and Topics in MDPI journals
Dr. Martin Teraa

E-Mail Website
Guest Editor
Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
Interests: peripheral artery disease (PAD); aortic pathology; endovascular interventions
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The prevalence of peripheral artery disease (PAD) and, in particular, chronic limb-threatening ischemia (CLTI) is increasing globally, not only in high-income countries but also in middle- and low-income countries. The rise in PAD and CLTI is leading to an increased need for, and complexity of, peripheral revascularizations, especially for below-the-knee (BTK) pathologies. The treatment of PAD has changed significantly over the past few decades, and an endovascular-first strategy has been adopted in most centers. In the contemporary era of endovascular therapy for PAD and CLTI, developments and innovations have followed each other at a great pace. Over the years, image guidance, endovascular materials, and revascularization techniques have evolved, enabling us to treat more complex cases. On one hand, the evolution of endovascular revascularization for the treatment of PAD opens doors for innovations related to interventional planning, imaging, techniques, the application of artificial intelligence (AI), and patient selection. On the other hand, there are also drawbacks, such as the negative effects of radiation exposure, discussions regarding long-term patency, and cost-effectiveness issues, which raise new research questions. This Special Issue will address topics that can keep us in the loop and help us to achieve faster, more effective, cheaper, and safer interventions, beneficial for (future) patients, interventionalists, and the healthcare system.

We would like to invite you to contribute an original research or review article to this Special Issue.

Dr. Constantijn E.V.B. Hazenberg
Dr. Martin Teraa
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • peripheral arterial disease (PAD)
  • chronic limb-threatening ischemia (CLTI)
  • below the knee
  • atherosclerosis
  • endovascular intervention
  • endovascular therapies
  • image-guided therapies

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Published Papers (2 papers)

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Research

11 pages, 883 KiB  
Article
Real-World 12-Month Outcomes with Sirolimus-Coated Balloon Angioplasty for Complex Femoropopliteal Disease
by Efthymios Beropoulis, Konstantinos Avranas, Elena Rouvi and Konstantinos P. Donas
J. Clin. Med. 2025, 14(2), 483; https://doi.org/10.3390/jcm14020483 - 14 Jan 2025
Viewed by 784
Abstract
Background: Sirolimus-coated balloons (SCBs) have emerged as a promising alternative to paclitaxel-coated devices for the treatment of femoropopliteal lesions. However, real-world data on SCB performance in also complex peripheral arterial disease remains unknown. We sought to evaluate the safety and 12-month clinical [...] Read more.
Background: Sirolimus-coated balloons (SCBs) have emerged as a promising alternative to paclitaxel-coated devices for the treatment of femoropopliteal lesions. However, real-world data on SCB performance in also complex peripheral arterial disease remains unknown. We sought to evaluate the safety and 12-month clinical outcomes of the Selution SLR™ balloon angioplasty in a challenging real-world patient cohort. Methods: This single-center, retrospective observational study with prospective follow-up included 21 patients with symptomatic peripheral arterial disease treated with the Selution SLR™ SCB (Med. Alliance, SA, Mont-sur-Rolle, Switzerland) after vessel preparation with rotational atherectomy, between October 2023 and November 2024. The primary endpoints were technical success, 12-month primary patency, and target lesion revascularization (TLR). Secondary endpoints included major adverse cardiac events (MACE), major adverse limb events (MALE), and changes in Rutherford classification and ankle-brachial index (ABI). Results: The median age was 79 years, with 47.6% of patients over 80 years old. Most patients presented with advanced peripheral atherosclerotic disease (PAD) (Rutherford category V, 47.6%). Lesions were predominantly occlusive (76.2%), with a median length of 130 mm and severe/moderate calcified in 71.4% of cases. Technical success was achieved in 95.2% of procedures. The 12-month primary patency was 95%, with a TLR-Rate of 5%. No major amputations or cardiovascular deaths occurred. Significant improvements in Rutherford category and ABI were maintained at 12 months. Conclusions: In this real-world cohort of patients with complex PAD, vessel preparation-assisted Selution SLR™ angioplasty demonstrated safety and promising 12-month outcomes. These findings support the use of SCBs in also challenging peripheral interventions, though larger-scale data and further follow up are needed in order to establish SCBs’ role as crucial in the treatment algorithm of PAD. Full article
(This article belongs to the Special Issue Revascularization Strategies in Peripheral Artery Disease and Chronic Limb-Threatening Ischemia: Current Standards and Future Perspectives)
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9 pages, 248 KiB  
Article
Availability of the Great Saphenous Veins as Conduits for Arterial Bypass Surgery in Patients with Varicose Veins
by Veronika Golovina, Vladislav Panfilov, Evgenii Seliverstov, Darina Erechkanova and Igor Zolotukhin
J. Clin. Med. 2024, 13(24), 7747; https://doi.org/10.3390/jcm13247747 - 18 Dec 2024
Viewed by 744
Abstract
Background: The great saphenous vein (GSV) has long been recognized as the best conduit for vascular bypass procedures. Concomitant varicose veins disease may be a reason for GSV unavailability either due to dilatation and tortuosity of the vein or due to its destruction [...] Read more.
Background: The great saphenous vein (GSV) has long been recognized as the best conduit for vascular bypass procedures. Concomitant varicose veins disease may be a reason for GSV unavailability either due to dilatation and tortuosity of the vein or due to its destruction during invasive venous treatment. Objectives—to assess the rate of varicose vein patients with concomitant lower extremity arterial disease (LEAD) who have previously lost their GSV due to venous ablation. Material and Methods: A total of 285 patients (76 F, 209 M) with LEAD were consecutively enrolled. A total of 111 patients (222 limbs) underwent a detailed duplex ultrasound of the lower extremity veins for assessing suitability of the GSV as a conduit. We registered presence of varicose veins (VVs), type of previous invasive procedure and availability of saphenous veins as possible grafts. Results: The mean age of screened patients was 70.5 ± 9.1.62 (21.75%) patients had varicose veins or were operated on before due to varicose veins. A total of 42 patients with varicose veins had C2 disease, 10 had C3, 9 had C4 and 1 had C6 according to CEAP classification. A total of 222 lower extremities were examined by duplex ultrasound of which 51 limbs had VVs. Despite the presence of varicose tributaries, the GSV was suitable for bypass in 9 of those lower extremities. The GSV was not available as a conduit in 34 (19.9%) ipsilateral lower extremities in the LEAD with no VVs group and in 42 (82.6%) ipsilateral lower extremities in the LEAD with VVs group (p = 0.0001). Varicose vein disease was associated with a higher frequency of the GSV unavailability (odds ratio 18.8, 95% confidence interval 8.35–42.35). On the 11 ipsilateral limbs (5% of LEAD patients and 21.6% of LEAD with VVs patients), the GSV was unavailable due to previous venous interventions. Conclusions: Almost 20% of patients may have both LEAD and VVs. Among those with VVs, most have the ipsilateral GSV unavailable as a potential conduit. Additionally, one fifth of limbs with VVs had GSVs destroyed previously due to saphenous ablative procedures. Full article
(This article belongs to the Special Issue Revascularization Strategies in Peripheral Artery Disease and Chronic Limb-Threatening Ischemia: Current Standards and Future Perspectives)
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