Commentary

A New Frontier: Below-the-Knee Intervention

In terms of new frontiers in cardiac intervention, few areas are as exciting as below-the-knee intervention. The possibility of providing extremely sick patients with a limb-saving and potentially life-altering therapy is really quite profound.

Typically, these patients with critical limb ischemia (CLI) are not great candidates for surgery because of concomitant CAD or other major comorbidities and are therefore particularly well-suited for endovascular approaches. It is becoming increasingly apparent that techniques gleaned from interventional cardiology can be very useful in treating below-the-knee disease. For example, many of the approaches in treating chronic total occlusions or complex PCI can be adapted to below-the-knee interventions. As well, advances in radial artery intervention and use of ultrasound for vascular access provide lessons for transpedal artery access.

The necessary knowledge to deal with these procedures extends beyond just technical expertise, but care of patients with CLI, while demanding, can be very fulfilling. Advances in drug-coated balloons, drug-coated stents and other adjunctive techniques will likely improve success rates and durability of below-the-knee intervention in the years to come.

In this issue of Cardiology Today’s Intervention, we gathered a number of experts to discuss this topic and provide their insights into below-the-knee intervention. Click here to read the Cover Story. Let us know your thoughts on the current state and future of below-the-knee intervention by emailing the editors at intervention@healio.com.

— Deepak L. Bhatt, MD, MPH

Chief Medical Editor

Cardiology Today’s Intervention

In terms of new frontiers in cardiac intervention, few areas are as exciting as below-the-knee intervention. The possibility of providing extremely sick patients with a limb-saving and potentially life-altering therapy is really quite profound.

Typically, these patients with critical limb ischemia (CLI) are not great candidates for surgery because of concomitant CAD or other major comorbidities and are therefore particularly well-suited for endovascular approaches. It is becoming increasingly apparent that techniques gleaned from interventional cardiology can be very useful in treating below-the-knee disease. For example, many of the approaches in treating chronic total occlusions or complex PCI can be adapted to below-the-knee interventions. As well, advances in radial artery intervention and use of ultrasound for vascular access provide lessons for transpedal artery access.

The necessary knowledge to deal with these procedures extends beyond just technical expertise, but care of patients with CLI, while demanding, can be very fulfilling. Advances in drug-coated balloons, drug-coated stents and other adjunctive techniques will likely improve success rates and durability of below-the-knee intervention in the years to come.

In this issue of Cardiology Today’s Intervention, we gathered a number of experts to discuss this topic and provide their insights into below-the-knee intervention. Click here to read the Cover Story. Let us know your thoughts on the current state and future of below-the-knee intervention by emailing the editors at intervention@healio.com.

— Deepak L. Bhatt, MD, MPH

Chief Medical Editor

Cardiology Today’s Intervention