Abstract
Drug-eluting resorbable scaffolds (DRS) have been developed to overcome the key limitations of conventional endovascular therapies for below-the-knee peripheral artery disease (PAD), including acute recoil, restenosis, and the sequela of long-term permanent metallic implants. DRS provides a temporary mechanical support and localized antiproliferative drug delivery after which the scaffold is gradually resorbed, ultimately restoring native vessel architecture to preserve future revascularization options. Over the past decade, numerous prospective and observational studies have evaluated both polymer- and magnesium alloy-based DRS platforms and have demonstrated favorable patency, wound healing, and limb salvage outcomes in patients with advanced infrapopliteal PAD. Most recently, randomized evidence from the LIFE-BTK trial has demonstrated superior patency and reduced rates of revascularization with DRS treated lesions as compared with plain balloon angioplasty. In this state-of-the-art review, we summarize the existing evidence evaluating DRS devices for below-the-knee PAD and present an updated systematic review and meta-analysis of clinical outcomes for DRS-based endovascular interventions.