Algorithm for the Revascularization of Infrainguinal Arterial Disease

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Endovascular Interventions

Background:

• Peripheral artery disease (PAD) affects over 200 million globally, characterized by arterial stenosis or occlusion.
• Infrainguinal arterial disease (IAD) is a common manifestation of PAD, posing complex revascularization challenges.
• Treatment decisions require careful consideration of patient factors and anatomical characteristics.

Purpose of the Study:

• To present a comprehensive algorithm for infrainguinal arterial disease (IAD) revascularization.
• To review and compare outcomes of various IAD treatment modalities.
• To guide optimal treatment selection for IAD.

Main Methods:

• Comprehensive literature review of studies comparing open, endovascular, and hybrid revascularization for IAD.
• Analysis of treatment outcomes including patency rates and freedom from revascularization.
• Evaluation of advancements in endovascular techniques and drug-based technologies.

Main Results:

• Endovascular therapy, including angioplasty and stenting, is standard for simple IAD.
• Advanced endovascular techniques and drug-eluting technologies improve outcomes for complex IAD.
• Percutaneous atherectomy offers plaque removal similar to surgical endarterectomy.

Conclusions:

• A structured algorithm is essential for selecting the optimal revascularization strategy for IAD.
• Evidence-based selection of open, endovascular, or hybrid approaches improves patient outcomes.
• Technological advancements enhance the efficacy and durability of IAD treatments.