Innovative techniques in lower extremity revascularization

Revascularization of the ischemic foot remains a significant challenge for even the most experienced vascular surgeons. Lower extremity revascularization can be accomplished by endarterectomy, endovascular techniques, or bypass. In experienced hands, excellent results have been reported with endarterectomy. However, this technique has limited application because of the diffuse nature of infrainguinal atherosclerotic disease. Endovascular techniques, such as atherectomy and laser-assisted balloon angioplasty, gained enormous popularity initially because they were less invasive than standard techniques. Unfortunately, the long-term results with these techniques have been disappointing.