Peripheral arterial disease: diagnosis and management

Recommendation ID: CG147/4
Question: Primary versus secondary stenting for treating people with critical limb ischaemia caused by disease of the infra-geniculate arteries:- What is the clinical and cost effectiveness of selective stent placement compared with angioplasty plus primary stent placement for treating people with critical limb ischaemia caused by disease of the infra-geniculate arteries?
Any explanatory notes (if applicable): Why this is important:- Studies comparing angioplasty plus selective stent placement with primary stent placement have been limited to the aorto-iliac and femoro-popliteal segment. There is also a significant group of people with critical ischaemia caused by disease of the infra-geniculate vessels in which there is a potential for endovascular treatment. Infra-geniculate disease is more complex to treat by endovascular means, and the risks and benefits of different treatment options may differ from those for the more proximal vessels. A multicentre, randomised controlled trial with a full health economic analysis is required to address the optimum policy as regards the choice of method for angioplasty and stent placement for the infra-geniculate arteries. The primary endpoint should be amputation-free survival, with secondary endpoints including overall survival, re-intervention rates, health-related quality of life, healing of tissue loss, and relief of ischaemic pain.

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Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	03/09/2012