Endovascular intervention for atherosclerotic occlusive disease of the lower extremities

       Peripheral Arterial Disease (PDA) is an important limb manifestation of atherosclerosis. With the improvement of the overall standard of living and the aging of the population, the incidence of lower extremity atherosclerosis and the number of patients who visit the clinic for lower extremity atherosclerosis occlusive disease will increase, and the various types of lower extremity atherosclerosis occlusive disease problems in clinical treatment will not continue to appear.       The PDA endovascular interventions for lower extremity atherosclerosis occlusive disease can only delay the progression of lower extremity atherosclerosis occlusive disease, but cannot fundamentally eliminate the stenosis and occlusion of lower extremity atherosclerosis occlusive disease vessels. Surgical endovascular debridement, artificial vessel replacement and bypass reconstruction for lower extremity atherosclerosis and occlusive disease are highly invasive and risky, especially not suitable for patients with lower extremity atherosclerosis and occlusive disease combined with serious cardiovascular and cerebrovascular disorders and diabetes mellitus. Endovascular interventions for lower extremity atherosclerosis have the advantages of being minimally invasive, simple, effective and repeatable, and are the direction of development in the diagnosis and treatment of vascular diseases.       Percutaneous balloon angioplasty Lower extremity atherosclerosis occlusive PTA is a major advancement in the treatment of vascular disease, and balloon angioplasty for lower extremity atherosclerosis occlusive disease (BaHoon Angioplasty) is now a relatively mature technique. The main mechanism of PTA for lower extremity atherosclerosis and occlusive disease is that balloon expansion separates the stenotic and sclerotic intima, while destroying the strong layer of smooth muscle and collagen fibers in the intima. Therefore, balloon vasodilation is a mechanical dilatation method that leads to vascular remodeling for the treatment of lower extremity atherosclerotic occlusive disease. In a group of patients with lower extremity atherosclerotic occlusive disease treated with femoral carotid intervention, Capek et al. reported in 1989 that the cumulative patency rates at 1, 3, and 5 years were 81%, 61%, and 58%, respectively. In contrast, Schwarten et al. in 1988 reported a 97% intervention success rate in 144 cases of lower extremity atherosclerotic occlusive disease below the carotid artery, with a 86% success rate of limb preservation at two years of follow-up. Also Capek he found in the treatment of lower extremity atherosclerosis occlusive disease that dorsalis pedis artery pulsation is a key factor in the success of PTA treatment of the femoral carotid artery, so he concluded that PTA treatment of the femoral carotid artery in lower extremity atherosclerosis occlusive disease combined with intervention below the ascending carotid artery could improve the long-term patency rate of PTA technique in lower extremity atherosclerosis occlusive disease.       Endovascular stenting (Stent) in lower extremity atherosclerosis occlusive PTA can lead to vascular entrapment tear and elastic retraction, while stenting overcomes the two major defects of PTA by squeezing the plaque and compressing the wall, and is a new endoluminal treatment for lower extremity atherosclerosis occlusive disease. trial (RPT) found significant differences in outcomes between two groups of patients with lower extremity atherosclerotic occlusive disease treated with lower extremity atherosclerotic occlusive disease stenting and lower extremity atherosclerotic occlusive disease treated with PTA alone, respectively, with a 2-year follow-up showing a 10%-15% higher lower extremity atherosclerotic occlusive disease patency rate in the former. Endovascular stents for lower extremity atherosclerosis occlusive disease are divided into two major categories according to whether balloon expandable tent is required or not: balloon expandable stent for lower extremity atherosclerosis occlusive disease and self-expandable stent for lower extremity atherosclerosis occlusive disease. Balloon expandable stents (Palmaz) were approved by the US FDA in the early 1990s for the treatment of atherosclerotic occlusive disease of the lower extremities with stenosis of the main iliac artery, which are rigid and can support longer stenotic occlusive lesions.