[Interventional therapy of peripheral arterial disease-potentials and limitations]

The technical success rate of endovascular interventions in order to improve perfusion in peripheral arterial disease in the lower extremities has been markedly improved in the last decade due to clinical application of new recanalization techniques like application of hydrophil-coated guide wires, implantation of stents or stent grafts. If the-even long-segment-obstruction can be recanalized, the interventional radiologist is able to open the arterial vessel sufficiently. The excellent immediate results are limited in the long term by recurrent stenoses, which appear in different rates according to the vascular region. Whereas recurrent stenoses have nearly no clinical significance in the aortoiliac vascular segment due to the size of the treated vessels and the excellent flow, there is a significant amount of restenoses in the femoropopliteal segment and, even more, in the tibial arteries. This leads to a different indication of endovascular therapy according to the segment treated. However, in an interdisciplinary consensus we offer primary endovascular therapy for treatment of aortoiliac obstruction to all patients, whereas lesions at the femoral bifurcation are a clear primary indication for open surgical treatment. In the femoropopliteal segment, we choose a primary endovascular procedure with respect to the length of the occlusion, patient's risk factors and comorbidities. Yet, longer obstructions are a clear indication for primary surgical treatment. In cases of infrapopliteal disease, we recommend an endovascular treatment as the initial option due to the reduced invasiveness of the predominantly old and multimorbid patient cohort. Further clinical research for the evaluation of endovascular therapeutic measures in peripheral arterial disease urgently requires outcome studies, which include clinically relevant endpoints to better define the clinical value of endovascular therapy compared to traditional surgical bypass procedures. Until new clinical trials will be published, the Transatlantic Consensus document (TASC) of a variety of vascularly specialized scientific societies seems to be a helpful guideline.