Endovascular Treatment of
Lower Extremity Arterial Disease
Intro to PAD Treatment Options
Peripheral artery disease (PAD) is treated most effectively by eliminating blockages in the arteries and restoring blood flow. Minimally invasive endovascular care is now the most common approach to revascularization.
In the hands of a dedicated Vascular Specialist, endovascular therapies can effectively restore blood flow to the lower extremities, reverse tissue loss, restore function, and salvage limbs on track for amputation. Here we provide a 101 on the treatment options available for lower extremity arterial disease, with a focus on endovascular techniques and technology for the primary care physician.
You can use this quick navigation list to learn more about a specific type of treatment:
Expert Endovascular Care
Dr. Michael Lalezarian
Adrianne S, October 2018
Medicines that specifically target claudication symptoms include Cilostazol and Naftidrofuryl. Cilostazol is currently the most effective medication for the management of claudication symptoms, allowing some patients to traverse greater distances. Naftidrofuryl can also help you achieve pain-free walking. Importantly, neither of these medications attack the root cause of peripheral artery disease.
The Endovascular Approach
The endovascular approach involves going directly into the blood vessel with catheter-based devices, such as balloons and stents, to treat the source of disease. Endovascular care is image-guided and can involve hybrid approaches. It may take place over multiple staged procedures with a multitude of techniques to ensure patient safety and optimal clinical outcomes. Endovascular treatments for PAD are provided by a Vascular Specialist trained in either minimally invasive revascularization therapy. When possible, catheter-based revascularization is typically recommended before surgery because it is less invasive and yields comparable or superior outcomes.
PAD can be categorized as above-the-knee (ATK) or below-the-knee (BTK) disease. The specific tools and devices used to accomplish minimally invasive revascularization will differ depending on the location of the obstructed artery, whether above or below the knee, with purpose-built devices for specific lesion morphology and anatomical location.
Thigh claudication and pain can also occur if arteries in the groin (the common femoral artery) or mid-thigh (the superficial femoral artery) are narrowed. Minimally invasive revascularization of these arteries in the femoropopliteal region of the leg usually involves treatment with balloon angioplasty and/or stents. The approach to stenting depends on the length of the obstructed segment. For shorter obstructions (less than 5 cm), balloon angioplasty alone often suffices. However, as the length and extent of the obstruction increases, so does the need for stenting.
Minimally invasive revascularization can still be performed in the calf, ankle, and foot. However, any PAD below the popliteal artery in the knee (the infrapopliteal segment) isn’t typically treated with an intervention like balloon angioplasty if the only symptom is claudication. Rather, infrapopliteal interventions are usually reserved for patients with late-stage PAD that has progressed to chronic limb-threatening ischemia with visible tissue loss.
Minimally Invasive Revascularization Technology
Balloon-expanded stent placed along an arterial lesion.
Bypass Surgical Revascularization
 Berger, JS., Davies, MG. Overview of lower extremity peripheral artery disease (Beyond the Basics). UptoDate. Accessed November 2020
 Dosluoglu, HH. Endovascular techniques for lower extremity revascularization. UpToDate. Accessed November 2020.
 Davies, MG. Management of claudication due to peripheral artery disease. UpToDate. Accessed November 2020.
 Patient education: Peripheral artery disease and claudication (The Basics). UpToDate. Accessed November 2020.
 Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality – Letter to Health Care Providers. www.fda.gov. Accessed November 2020.
 Baerlocher (2015). Meta-Analysis of Drug-Eluting Balloon Angioplasty and Drug-Eluting Stent Placement for Infrainguinal Peripheral Arterial Disease. Journal of Vascular and Interventional Radiology, 26(4), 459–473.e4.
 Gerhard-Herman (2017). 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary. Journal of the American College of Cardiology, 69(11), 1465–1508.
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