[Surgical treatment of atherosclerosis in the lower limbs]

Walking exercise, smoking cessation and best medical therapy are cornerstones in all treatment of atherosclerosis. For patients with intermittent claudication or critical limb ischemia, endovascular therapy (which has developed substantially during the last decade) has become the first line treatment (when feasible). The aim of this article is to provide an overview of options for surgical treatment of peripheral atherosclerosis in the lower limbs.

The article is based on literature identified through a non-systematic search in PubMed, vascular textbooks and the authors' own clinical experience.

When endovascular therapy has failed or is not feasible, open surgical techniques are used, such as endarterectomy and bypass surgery to the popliteal or distal arteries. Hybrid procedures, with femoral endarterectomy and distal or proximal endovascular intervention, are often used. Increased use of endovascular treatment reduces the procedural time, length of hospital stay and the rate of complications. In patients with extreme disease progression, primary amputation may still be the treatment of choice.

Surgical treatment of peripheral artery disease requires competence both within radiological intervention and open surgical treatment modalities.