Surgical Technique and Peripheral Artery Disease

I nvasive treatment for patients with peripheral artery disease (PAD) has changed dramatically. Medicare claims data from 1996 to 2006 reveal an almost doubling of lower-extremity vascular procedures: The use of endovascular repair increased 3-fold, bypass surgery decreased 42%, and the amputation rate decreased by 29%. 1 For patients admitted to hospital for PAD between 1996 and 2005, the likelihood of undergoing surgery decreased from 34.5% to 26.3%. 2 Although the rate of bypass is decreasing, surgery remains an important component in the armamentarium for treating patients with advanced vascular disease. Surgical revascularization is indicated in patients with acceptable surgical risk who require a more durable repair, in those with lesions technically unsuitable for endovascular repair, and in patients who experienced failure of endovascular repair.