Adjuvant Therapy in Lower Extremity Revascularization: Prevention of Early and Intermediate Failures

Open surgical or endovascular revascularization of the lower extremity is not always successful. Early and intermediate-term failures of vascular grafts, stents, and stent grafts occur due to technical mistakes, thrombosis, or intimal hyperplasia. The outcome of lower extremity revascu larization can be improved by adjuvant antithrombotic treatment (antiplatelet drugs, anticoagulation) and by antiproliferative therapy such as drugs, brachytherapy, or gene therapy. Adjuvant drug therapy can be sys temic (oral or parenteral) or local (direct injection or placement of drug-elut ing grafts or stents). Systemic drug therapy may carry the additional benefit of preventing cardiovascular events, such as stroke or myocardial infarction. Unfortunately, it can also be associated with serious, mainly hemorrhagic, adverse effects. We review the English-language literature of antithrombotic and antiproliferative adjuvant therapies in the prevention of early and inter mediate failures following lower extremity revascularizations.