Revascularization for peripheral arterial disease (PAD): Endovascular therapies

Revascularization is the only definitive treatment in PAD causing refractory life style limiting claudication despite maximal medical therapy, or in presence of critical limb ischemia. Endovascular treatment is the treatment of choice for aortoiliac, femoropopliteal and infrapopliteal disease with surgical treatment reserved for instances where the anatomy is unfavorable for endovascular therapy. For TASC A and B lesions (short non-occlusive, non-complex lesions), percutaneous transluminal angioplasty (PTA) alone is regarded as the safe and effective alternative in the management. However, there is disadvantage of residual stenosis and late restenosis with this approach. Indications for stent placement after PTA are a residual stenosis more than 30% as measured by angiography, a pressure gradient of = 5 mmHg or presence of an intimal dissection. Current recommendations are to perform PTA followed by stenting (if needed) for TASC type A and B lesions. Endovascular treatment options for aortoiliac disease, femoropopliteal disease and infrapopliteal disease are discussed in detail in this chapter.