Peripheral Artery Disease: Review
Peripheral arterial disease (PAD) is primarily driven by atherosclerosis related to hypertension, diabetes mellitus, hyperlipidemia, and smoking, with microvascular and endothelial dysfunction exacerbating disease progression and complications.
Duplex ultrasound (DUS) is recommended as the first-line, non-invasive imaging modality for PAD diagnosis and surveillance, offering high sensitivity and specificity in most arterial segments while avoiding contrast or radiation exposure, particularly beneficial for patients with renal impairment.
Optimal medical management for PAD includes aggressive risk factor modification (smoking cessation, statin therapy regardless of baseline LDL, antihypertensive therapy, antithrombotic agents—preferably single antiplatelet, and glycemic control in diabetes), with strong evidence supporting supervised exercise therapy for symptomatic relief in claudication.
Endovascular interventions, such as balloon angioplasty (including drug-coated and lithotripsy balloons) and stent placement (preferably nitinol or covered stents for specific lesions), are generally preferred over surgical revascularization for aortoiliac and femoropopliteal disease due to lower morbidity, comparable limb salvage, and improved quality of life outcomes.
Surgical bypass remains the gold standard for complete femoropopliteal occlusions and long or complex lesions, but is associated with higher perioperative morbidity and mortality, making endovascular-first strategy preferable in most other anatomical locations or high-risk patients.
In endovascular therapy, advancements such as 2D fusion imaging and retrograde re-entry catheters have significantly reduced radiation and contrast loads while increasing technical success rates, particularly for chronic total occlusions and challenging anatomy.The choice of revascularization strategy must be individualized based on anatomic lesion (TASC II classification), patient comorbidities and surgical risk, with endovascular-first approaches supported for most lesions except for certain complex infrapopliteal or common femoral artery diseases where open surgery or endarterectomy may yield superior long-term patency.
earn CME at app.embllm.com
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