Remarkable technological advances in the past two decades, along with patient preference, have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments. Catheter-based revascularization of the lower extremities was first performed then newly developed is inflatable balloon catheters that could dilate vascular narrowings or blockages caused by atherosclerosis. The availability of stents, atherectomy devices,re-entry devices and other technologies has fueled the growth of catheter-based procedures by improving the safety, durability, and predictability of percutaneous revascularization.
Endovascular therapy offers several distinct advantages over open surgical revascularization for selected lesions. It is performed with local anesthesia, which enables the treatment of patients who are at high risk for general anesthesia. The morbidity and mortality from catheter-based therapy is extremely low, especially compared with open surgical revascularization. After successful percutaneous revascularization, patients are ambulatory on the day of treatment, and unlike after vascular surgery, they can often return to normal activity within 24 to 48 hours of an uncomplicated procedure. Endovascular therapies generally do not preclude or alter subsequent surgery and may be repeated if necessary.
Multiple specialties, including interventional cardiology, have contributed to the advancement of the field of peripheral vascular intervention over the past several decades. Improved patient and physician awareness of PAD and the availability of high-quality noninvasive diagnostic imaging have increased the number of patients seeking treatment for PAD.