Endovascular treatment of lower extremity peripheral arterial disease

Peripheral arterial disease (PAD) is extremely prevalent, under-diagnosed and has a tremendous impact on the quality of life of patients with this condition. The foundation of PAD treatment is medical therapy in order to prevent its associated high rates of cardiovascular morbidity and mortality. This therapy should be instituted in all patients with PAD, regardless of symptomatic status. Though the majority of patients with PAD are asymptomatic, they remain at high risk for adverse events, underscoring the need to screen for this disease. This review will briefly touch on the medical therapy for PAD and highlight the necessity to make the diagnosis in all patients at risk. For those patients with symptoms from arterial insufficiency, the frontier of potential treatment options is ever expanding. In this review, the current options for patients with symptomatic lower extremity PAD are highlighted. Given the marked differences in treatment options and outcomes between the aorto-iliac, femoropopliteal and infrapopliteal vascular beds, each of these arenas are discussed separately. Contemporary techniques and data are discussed with respect to both vascular bed and presenting clinical scenario, i.e. claudication, critical limb ischemia and acute limb ischemia.