The Role of Endovascular Therapy in Peripheral Arterial Disease

Abstract

Many vascular specialists have embraced endovascular therapy as the first-line treatment for patients with peripheral arterial disease (PAD) and lifestyle-limiting claudication or critical limb ischemia. Compared to surgical bypass, infrainguinal endovascular interventions are associated with reduced durability. These minimally invasive procedures, however, are associated with an improved safety profile and lower morbidity compared to open surgical bypass, even in the setting of significant medical comorbidities. Given the widespread application of endovascular therapy to the treatment of PAD, it is imperative that practitioners involved in the management of patients with PAD and diabetes understand the strengths and weaknesses of endovascular techniques and devices, peri-procedural management, expected results, and outcome measures. This chapter reviews fundamental principles of infrainguinal endovascular therapy for PAD, with specific attention to treatment guidelines and the impact of diabetes and other comorbidities and lesion characteristics on long-term outcome after endovascular therapy.KeywordsEndovascularAngioplastyAtherectomyOutcomes