Endovascular Treatment of Infrapopliteal Peripheral Artery Disease

Endovascular treatment of infrapopliteal disease is focused on the treatment of patients with rest pain or critical limb ischemia (CLI) due to severe atherosclerotic disease. While the evidence base surrounding the comparative effectiveness of endovascular intervention vs. surgery is lacking, many operators have adopted an "endovascular first" approach to the treatment of infrapopliteal atherosclerotic disease due to the lower morbidity of these procedures. This manuscript reviews current data on the endovascular treatment of CLI, including a comparison of endovascular and surgical approaches, current indications for and outcomes with balloon angioplasty of infrapopliteal PAD, angiosome-guided revascularization, and emerging technologies to improve long-term vessel patency after endovascular intervention.