[New techniques for the endovascular treatment of peripheral arterial disease]

Peripheral arterial disease of the lower limb is a manifestation of atherosclerosis, with a prevalence ranging from 4 to 12% in the adult population and increasing up to 20% in elderly individuals (i.e.>70 years old). Peripheral arterial disease is a marker of systemic atherosclerosis and is associated with increased cardiovascular morbidity and mortality. Therapeutic strategies are firstly aimed at reducing systemic cardiovascular risk burden. Therefore, intensive risk factor modification, and antiplatelet therapy should be implemented in all patients with peripheral arterial disease. Endovascular and surgical treatment are often highly valuable to improve rest pain and ulcer healing. The initial work-up includes non-invasive measurement of the ankle-brachial index, as well as measurement of the toe pressure. In case of a severe ischemia-ankle pressure inferior or equal to 50 mmHg and/or toe pressure inferior or equal to 30 mmHg--a revascularisation attempt should be proposed. We discuss here some recent advances in the endovascular field. Technical aspects of sub-intimal vs intraluminal recanalisation will be discussed, focusing on the different kinds of devices (e.g. crossing, reentry, debulking devices) actually at the interventionist's disposal. As endovascular techniques are constantly evolving, a multidisciplinary approach, including all cardiovascular specialists, is often needed.