Percutaneous interventions for lower-extremity peripheral atherosclerotic disease.

Patients with peripheral arterial disease frequently develop symptoms of claudication that interfere with ambulation and adversely affect quality of life, and some develop critical limb ischemia. Many of these patients have coexisting coronary artery disease, and surgical revascularization poses risks of perioperative myocardial infarction and cardiovascular death. Peripheral catheter-based interventions are a feasible alternative. Percutaneous treatment can preserve the surgical option and is often used as an adjunct to surgery by addressing inflow stenoses and limiting the extent of surgical reconstruction that is necessary. Iliac artery balloon angioplasty has been shown to have a high rate of initial procedural success and long-term patency, and the use of stents is promising, especially in cases complicated by flow-limiting dissection or significant residual stenosis. Percutaneous revascularization of the femoropopliteal arteries has shown high restenosis rates and stents should be confined, at present, to flow-limiting dissections or inadequate results from balloon angioplasty alone. The indication for percutaneous revascularization below the knee is typically limited to those patients with critical limb ischemia who are at high risk for surgical reconstruction; short-term results with modern equipment have been promising and can salvage ischemic limbs.