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STATE-OF-THE-ART PAPER

Current Treatment of Peripheral Arterial Disease

Role of Percutaneous Interventional Therapies

Ehtisham Mahmud, MD^_*,_*, Jeffrey J. Cavendish, MD and Ali Salami, MD^_*

^_* Division of Cardiovascular Medicine, University of California, San Diego School of Medicine, San Diego, California
Naval Medical Center, San Diego, California.

Manuscript received October 17, 2006; revised manuscript received March 12, 2007, accepted March 14, 2007.

^_* Reprint requests and correspondence: Dr. Ehtisham Mahmud, Director, Cardiovascular Catheterization Laboratories, University of California, San Diego Medical Center, 200 West Arbor Drive, San Diego, California 92103-8784. (Email: emahmud{at}ucsd.edu).

Despite advances in medical therapies to help prevent the development of atherosclerosis and improve the management of patients with established peripheral arterial disease (PAD), the prevalence of PAD and associated morbidity remains high. Over the past decade, percutaneous revascularization therapies for the treatment of patients with PAD have evolved tremendously, and a great number of patients can now be offered treatment options that are less invasive than traditional surgical options. With the surgical approach, there is significant symptomatic improvement, but the associated morbidity and mortality preclude its routine use. Although newer percutaneous treatment options are associated with lower procedural complications, the technical advances have outpaced the evaluation of these treatments in adequately designed clinical studies, and therapeutic options are available that may not have been rigorously investigated. Therefore, for physicians treating patients with PAD, an understanding of the various therapies available, along with the inherent benefits and limitations of each treatment option is imperative as a greater number of patients with PAD are being encountered.

Abbreviations and Acronyms   AAA = abdominal aortic aneurysm   BE = balloon expandable   BMS = bare-metal stent(s)   CABG = coronary artery bypass graft   CAD = coronary artery disease   CEA = carotid endarterectomy   CTO = chronic total occlusion   DES = drug-eluting stent(s)   LAD = left anterior descending coronary artery   LIMA = left internal mammary artery   MI = myocardial infarction   PAD = peripheral arterial disease   RAS = renal artery stenosis   SE = self-expanding   SFA = superficial femoral artery

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