The Future of Treatment Models in Peripheral Artery Disease: Surgical and Endovascular Approaches
Abstract
Peripheral artery disease (PAD) affects over 200 million people worldwide, leading to significant morbidity and mortality. Treatment strategies have evolved from traditional surgical revascularization to minimally invasive endovascular techniques. Recently, hybrid procedures combining surgical and endovascular approaches have emerged as a promising alternative to optimize patient outcomes. This review compares the efficacy, benefits, and limitations of these treatment modalities in PAD management.
A comprehensive analysis of recent randomized controlled trials, cohort studies, and systematic reviews was conducted using PubMed, Scopus, and Web of Science. Key metrics, including patency rates, complication profiles, amputation-free survival, and patient-reported outcomes, were evaluated. Findings suggest that surgical revascularization remains the gold standard for complex PAD cases due to superior long-term patency, despite higher perioperative risks. Endovascular interventions, such as angioplasty and stenting, offer lower short-term complications and faster recovery but are associated with higher restenosis rates. Hybrid procedures provide an alternative for high-risk patients and complex lesions, integrating the advantages of both techniques. Technological advancements, including drug-coated devices and precision imaging, continue to refine treatment outcomes.
The choice of optimal PAD treatment depends on lesion complexity, patient comorbidities, and durability requirements. While surgical approaches provide long-lasting results, endovascular techniques offer less invasive solutions with lower immediate risks. Hybrid strategies bridge these approaches, improving outcomes in select cases. Future research should focus on long-term comparative studies and personalized treatment models to enhance clinical decision-making in PAD management.
Keywords
Peripheral artery disease, critical limb ischemia, surgical revascularization, endovascular treatment, hybrid procedures, multidisciplinary approaches.
Supporting Institution
No external funding was received for the preparation of this manuscript.
Ethical Statement
N/A
Thanks
N/A
References
- [1] Song P, Zhang Y, Yu C, Yang L, Zhu Y, Li X, et al. Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. The Lancet Global Health. 2019;7(8):e1020-e1030. https://doi.org/10.1016/S2214-109X(19)30255-4.
- [2] Thukkani AK, Kinlay S. Endovascular intervention for peripheral artery disease. Circulation Research. 2015;116(9):1599-1613. https://doi.org/10.1161/CIRCRESAHA.116.303503.
- [3] Howard R, Brown K, Smith T, Johnson A, Williams M, Lee D, et al. Identifying potentially avoidable femoral to popliteal expanded polytetrafluoroethylene bypass for claudication using cross-site blinded peer review. Journal of Vascular Surgery. 2023;77(2):490-496. https://doi.org/10.1016/j.jvs.2022.09.005.
- [4] Shishehbor MH, Jaff MR. Percutaneous therapies for peripheral artery disease. Circulation. 2016;134(24):2008-2027. https://doi.org/10.1161/CIRCULATIONAHA.116.022546.
- [5] Vartanian SM, Conte MS. Surgical intervention for peripheral arterial disease. Circulation Research. 2015;116(9):1614-1628. https://doi.org/10.1161/CIRCRESAHA.116.303504.
- [6] Lepäntalo MJ, Riekkinen H, Söderström M, Albäck A, Railo M, Malmivaara A, et al. Lower extremity bypass vs endovascular therapy for young patients with symptomatic peripheral arterial disease. Journal of Vascular Surgery. 2012;56(2):545-554. https://doi.org/10.1016/j.jvs.2012.06.053.
- [7] Lawall H, Bramlage P, Amann B, Barbera L, Stegmayr B, Hopp H, et al. The diagnosis and treatment of peripheral arterial vascular disease. Deutsches Ärzteblatt International. 2016;113(43):729-734. https://doi.org/10.3238/arztebl.2016.0729.
- [8] Wolosker N, Puech-Leão P, Nishinari K, Pinto IM, Ritti-Dias RM, Rossi FH, et al. Epidemiological analysis of lower limb revascularization for peripheral arterial disease over 12 years on the public healthcare system in Brazil. Jornal Vascular Brasileiro. 2022;21:e20210215. https://doi.org/10.1590/1677-5449.202102152.
- [9] Goodney P, Schermerhorn M, Powell R, Jones D, Giordano A, Patel A, et al. National trends in lower extremity bypass surgery, endovascular interventions, and major amputations. Journal of Vascular Surgery. 2009;50(1):54-60. https://doi.org/10.1016/j.jvs.2009.01.035.
- [10] Bradbury AW, Adam DJ, Bell J, Lee AJ, Ruckley CV, Forbes JF, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366(9501):1925-1934. https://doi.org/10.1016/S0140-6736(05)67704-5.
