Optimizing Endovascular Treatment of Lower Extremity Arterial Occlusive Disease

Lower extremity peripheral arterial disease (PAD) is the third leading cause of atherosclerotic vascular morbidity (after coronary heart disease and stroke) and is associated with significant morbidity, mortality and quality of life impairment. Symptoms vary from reduced walking distance, to rest pain and tis sue gangrene due to impaired blood flow to the extremities.
Selecting the best treatment modality for patients with symptomatic PAD is determined by patient factors such as age, severity of disease and comorbidities, as well as lesion characteristics, such as location, lesion length and calcification.
Bypass surgery and endarterectomy provide excellent long-term patency rates, however these are obtained at the price of high morbidity and mortality rates.
Endovascular treatment has good safety and short-term efficacy with decreased morbidity, complications and costs compared with open surgical procedures. However long time durability is dissapointing.
In the frail and aging vascular patients, endovascular treatment gains popularity because of its minimally invasive character, with increasing durability. Improved outcomes after endovascular treatment of PAD are the result of technical innovations as well as optimized treatment strategies. This thesis aims to provide insight in these recent treatment strategies and the use of new devices.
Treatments and outcomes of importance differ between the different vascular territories, therefore this thesis is divided in different parts and covers; Stent placement in endovascular treatment of iliac artery occlusive disease; Endovascular treatment of femoropopliteal artery occlusive disease; Endovascular treatment of autologous bypass grafts; Angiosome concept theory.