What is the efficacy of surgical intervention for the treatment of peripheral arterial occlusive disease (PAOD)?

Updated: Sep 12, 2019
  • Author: Josefina A Dominguez, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Along with the proliferation of endovascular procedures, a development of particular note has been the concurrent decrease in amputation rates for patients with PAOD. Unfortunately, factors directly contributing to lower amputation rates are difficult to delineate; they probably involve some combination of improved disease screening and patient awareness, better medical therapy, and evolving surgical device and technical modalities.

A few studies have directly compared endovascular and open surgical treatment options for patients with symptomatic PAOD. Unfortunately, a meta-analysis of four randomized control trials and six observational studies was unable to establish any well-defined superiority for either approach. Overall, recommendations for selecting a treatment modality may depend on the patient’s life expectancy and comorbid conditions, as well as on the extent of the occlusive disease. [23]

In October 2014, the US Food and Drug Administration (FDA) approved the first drug-coated balloon (DCB) for the treatment of peripheral arterial vascular disease, the Lutonix 035 Drug Coated Balloon Percutaneous Transluminal Angioplasty Catheter (Lutonix, New Hope, MN). [24]  The device is coated with paclitaxel and intended for use to treat stenotic or obstructive lesions in the femoropopliteal arteries to improve limb perfusion. Similar devices that are available include In.Pact Admiral (Medtronic Vascular, Santa Rosa, CA) and Stellarex (Spectranetics, Colorado Springs, CO).


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