2021/06/10 by Joshua A. Beckman, Peter A. Schneider, Michael S. Conte · 236 citations
Medicine · #Arterial disease #Cardiology #Cerebrovascular and Carotid Artery Diseases #Claudication #Critical limb ischemia #Diagnosis and Treatment of Venous Diseases #Intermittent claudication #Internal medicine #Medicine #Myocardial infarction #Peripheral Artery Disease Management #Revascularization #Surgery #Vascular disease
paper · pdf · doi:10.1161/circresaha.121.318261
published in Circulation Research 128(12), 1885-1912 (Lippincott Williams & Wilkins)
openalex publication_date 2021/06/10 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/27
Effective revascularization of the patient with peripheral artery disease is about more than the procedure. The approach to the patient with symptom-limiting intermittent claudication or limb-threatening ischemia begins with understanding the population at risk and variation in clinical presentation. The urgency of revascularization varies significantly by presentation; from patients with intermittent claudication who should undergo structured exercise rehabilitation before revascularization (if needed) to those with acute limb ischemia, a medical emergency, who require revascularization within hours. Recent years have seen the rapid development of new tools including wires, catheters, drug-eluting technology, specialized balloons, and biomimetic stents. Open surgical bypass remains an important option for those with advanced disease. The strategy and techniques employed vary by clinical presentation, lesion location, and lesion severity. There is limited level 1 evidence to guide practice, but factors that determine technical success and anatomic durability are largely understood and incorporated into decision-making. Following revascularization, medical therapy to reduce adverse limb outcomes and a surveillance plan should be put in place. There are many hurdles to overcome to improve the efficacy of lower extremity revascularization, such as restenosis, calcification, microvascular disease, silent embolization, and tools for perfusion assessment. This review highlights the current state of revascularization in peripheral artery disease with an eye toward technologies at the cusp, which may significantly impact current practice.