Contemporary management of peripheral arterial disease: III. Endovascular and surgical management
Amjad AlMahameed, MD, MPH, FACP
Division of Cardiology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA
Deepak L. Bhatt, MD, FACC, FSCAI, FESC, FACP
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
Correspondence: Amjad AlMahameed, MD, Division of Cardiology, Beth Israel Deaconess Medical Center, Cardiology-W/Baker 4, One Deaconess Road, Boston, MA 02215; firstname.lastname@example.org
Dr. AlMahameed reported that he has received honoraria for teaching and speaking from Sanofi-Aventis, GlaxoSmithKline, and Pfizer.
Dr. Bhatt reported that he has received honoraria for teaching, speaking, and consulting from Sanofi-Aventis and from Bristol-Myers Squibb.
At the time this article was written, Dr. AlMahameed was on the staff of the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH.
Traditional indications for invasive treatment in patients with peripheral arterial disease (PAD) have been salvage of a threatened limb or improvement of functional capacity in cases of disabling intermittent claudication, but advances in interventional therapy may be lowering the threshold for these therapies. Percutaneous transluminal angioplasty (PTA), with or without stent placement, is the most common endovascular intervention in patients with occlusive lower extremity PAD. In general, PTA is best suited to cases of short-segment stenosis or large-bore vessels, whereas surgery is best applied to multilevel occlusions involving smaller and more distant vessels. This article reviews endovascular therapy, catheter-based thrombolysis, and surgical revascularization procedures in patients with PAD, with special attention to recommendations from new American College of Cardiology/American Heart Association guidelines.