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Expert offers algorithm for endovascular options in PAD

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Thomas Zeller

HOLLYWOOD, Fla. — Many ballooning and stenting options exist for treatment of peripheral artery disease. An algorithm to decide which technologies to use in which patients may be helpful for interventionalists, an expert said at the International Symposium on Endovascular Therapy.

Thomas Zeller, MD, PhD, head of the department of angiology at the University Heart Center Freiburg-Bad Krozingen in Germany, shared with the ISET 2019 audience the algorithm that he uses for procedures to treat PAD, which is as follows:

• For patients with TASC A and B femoropopliteal lesions and zero to moderate calcium, predilatate the lesion with an undersized plain balloon, which is typically what one would do if a drug-coated balloon was going to be the treatment, Zeller said. If there is a good result, use a DCB according to the reference vessel diameter plus 1 mm, adding a bare-metal stent for spot stenting if necessary. If there is severe dissection or recoil, use a drug-eluting stent or an interwoven nitinol stent (Supera, Abbott), or use the combination of atherectomy and a DCB.

• For patients with TASC A and B femoropopliteal lesions and severe calcium, predilatate the lesion with a regular-sized plain balloon, which is typically what one would do if a DCB was going to be the treatment, Zeller said. If there is a good result, use a DCB according to the reference vessel diameter plus 1 mm, adding a dedicated calcium stent if indicated. If there is a suboptimal result, use a DES or an interwoven nitinol stent. The combination of atherectomy and a CBD may be considered.

• For patients with TASC C and D femoropopliteal lesions, predilatate the lesion with a regular-sized plain balloon, which is typically what one would do if a DCB was going to be the treatment, Zeller said. If there is a good result, use a DCB according to the reference vessel diameter plus 1 mm, adding a BMS if indicated. If there is severe dissection or recoil, use a DES, an interwoven nitinol stent or an endoprosthesis (Viabahn, W.L. Gore and Associates). The combination of atherectomy plus a DCB may be considered, but evidence for it in this population is uncertain, he said.

“There are a lot of data on DES and DCB,” he said. “This is my perspective on when to use them and why.” – by Erik Swain

Reference:

Zeller T. Townhall. Presented at: the International Symposium on Endovascular Therapy (ISET); Jan. 27-30, 2019; Hollywood, Fla.

Disclosure: Zeller reports he has financial ties with Abbott Vascular, Biotronik, Boston Scientific, Cook Medical, Medtronic, Philips/Spectranetics, QT Medical, Shockwave Medical, Terumo, TriReme, Veryan and W.L. Gore and Associates.