A Review of Peripheral Vascular Intervention Technologies

Background/Objectives: Chronic limb-threatening ischemia (CLTI) is the end stage of peripheral arterial disease (PAD) and leads to severe morbidity and mortality. With an increase in diabetes mellitus (DM) and an aging population, tibial artery CLTI is becoming more prevalent. Conventional endovascular devices are often limited by both length and size, highlighting the need for improved endovascular microcatheters. Methods: Here we provide a narrative review of CLTI in tibial disease and current treatment options, highlighting current endovascular techniques, the mechanics and challenges of current catheters, and call attention to the need for novel micro-steerable catheters. Results: Although PAD endovascular treatments have advanced over the past several decades, active tip steering for tibial and intrahospital microcatheters remains limited and without prospective clinical outcome data despite broader advances in peripheral endovascular therapy and catheter tip steering for larger vessels. Challenges in developing steerable microcatheters include the geometry and mechanics of the catheter’s tip on a microscale (50 µm–900 µm). Micro-fabrication methods have shown early promise in creating intricate microstructures; however, challenges remain in precise fabrication and assembly. Further research and development of novel microcatheters for the treatment of tibial disease is needed, as larger steerable catheters have been shown to improve patient outcomes with decreased procedure time, fluoroscopy time, required contrast, and procedural complications. Conclusions: The refinement of steerable micro catheters in tibial vessel intervention would expand current endovascular treatment and diagnostic capabilities, likely improving patient outcomes.