Is the drug-eluting balloon the answer to the epidemic of restenosis?

摘要

Lower extremity bypasses average 40 to 60 cm in length and are generally reserved for patients with extensive atherosclerotic disease not otherwise amenable to endovascular treatment. The preferred conduit is autogenous vein, which has a 12-month primary patency rate ranging from 66% to 80%, while bypasses constructed with prosthetic grafts have considerably inferior patency. With the recent trend in practice patterns, there has been a decline in bypass surgery and a rise in endovascular lower extremity revasculariza-tion. However, the increase in endovascular procedures has outpaced the decline of bypass surgery by a factor of 3:1, resulting in an overall total rise in peripheral interventions. This suggests that either the threshold for intervention has dropped or the number of repeat revascularizations for restenosis has increased. It is probably both. Currently, over half of all bypass surgeries are being performed following failure of a prior revascular-ization attempt.