Authors' objectives:

To assess the clinical efficacy and safety of endovascular stents in the treatment of peripheral arterial disease for lower limbs, at the request of the Society for Interventional Radiology and the Society for Angiology and Vascular Surgery.

Authors' recommendations: Although it is not possible to compare the efficacy and effectiveness of the three techniques with the present scientific evidence, there is some consensus among experts for assigning a role to each technique. Conventional surgery is more effective as a treatment for extensive arterial stenosis and occlusions. When an extensive bilateral aortoiliac arteroesclerotic process is present, when stenosis of iliac arteries goes with other processes that require aortic or iliac surgery, and when the damage is focused in the infrapopliteal area. PTA should be reserved for the patients with short stenosis and small occlusions. It is an alternative option for the rest of patients (extensive lesions) when surgery is not recommended because patient general conditions. It should be used as an adjuvant technique for stents, and as a secondary therapy for problems and rejections appeared when using the other techniques. Stents can be selected as an initial treatment for occlusive dissections of the intima, extensive stenosis in the iliac arteries, iliac artery occlusions, intimal flaps, focal aneurysms, and ulcerated plaques that can be followed by a distal embolus, and unsatisfactory PTA. Endovascular procedures can be performed in conjunction with surgery for proximal or distal stenosis to the vascular area subjected to surgery, and for the treatment of late problems (occlusions and/or stenosis) of high risk grafts. Furthermore, patients with high risk for surgery, and rejected for conventional surgery, can obtain some benefits from the endovascular procedures, PTA and/or stent. Surgery results are better than those obtained with endovascular techniques for the treatment of the femoropopliteal arterial lesions. PTA has to be restricted to patients with small stenosis, or occlusions, being stated that they will not affect the origin of femoral artery or the distal portion of popliteal artery. Stents use in femoropopliteal arterial lesions should be restricted to acute vascular occlusions during an PTA performance.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.isciii.es/aets

Year Published: 1996

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Evaluacion de Tecnologias Sanitarias

Contact Address: Instituto de Salud "Carlos III", Calle Sinesio Delgado 6, Pabellon 4, 28029 Madrid, Spain. Tel: +34 9 1 822 2005; Fax: +34 9 1 387 7841;

Contact Name: Luis M. Sánchez Gómez

Contact Email: luism.sanchez@isciii.es

Copyright: Agencia de Evaluacion de Tecnologias Sanitarias (AETS)