Optimising vessel preparation and treatment strategies in peripheral arterial disease

A comprehensive review that explores modern approaches to managing peripheral arterial disease (PAD) through endovascular techniques.

PAD is a prevalent but underdiagnosed condition affecting the lower extremities, often leading to significant morbidity. Endovascular therapy has become the preferred revascularisation strategy due to its lower risk profile compared to surgical options. However, complex lesions, such as those with severe calcification or chronic total occlusions, pose challenges to procedural success and long-term patency.

Effective vessel preparation is essential to optimise outcomes, improve arterial compliance and enhance drug uptake, particularly when using drug-coated balloons (DCB). Techniques like atherectomy, intravascular lithotripsy, scoring balloons and longitudinal microincision systems are tailored to lesion morphology and severity. These methods facilitate better luminal gain and reduce complications such as dissection and restenosis.

Treatment modalities including DCBs, bare metal stents, drug-eluting stents and covered stents offer targeted solutions, with efficacy closely tied to prior vessel preparation.

The review emphasises a personalised, image-guided approach to PAD management, integrating advanced technologies and evidence-based strategies. As innovations continue to evolve, clinicians must stay informed to deliver safe, effective and durable interventions for patients with PAD.

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