Is there a role for embolic protection during treatment of critical limb ischemia?

Endovascular therapy is a mainstay of treatment for patients with critical limb ischemia, who may otherwise be poor surgical candidates. A common and potentially devastating complication of endovascular lower extremity peripheral intervention is distal thromboembolism. Distal thromboembolism occurs more frequently than previously reported, particularly after interventions including atherectomy, recanalization and thrombolysis. Embolic protection devices (EPDs) have recently been applied to the infrainguinal arterial circulation, although no specific EPD has been designed for the lower extremity peripheral intervention. Preliminary studies have demonstrated safety and feasibility of EPD in this vascular territory. Clinical use has increased without a clear consensus as to which patients and which anatomic or lesion characteristics portend a higher risk for distal embolization. The purpose of this article is to examine the reasons why patients with critical limb ischemia may benefit from the use of EPDs during lower extremity endovascular intervention. Additional investigation is required in order to determine the precise role of EPDs for patients with critical limb ischemia undergoing peripheral arterial intervention.