Endovascular treatment offers a lower risk alternative to open surgery in many patients with multiple comorbidities. Noninvasive physiological tests and arterial imaging precede an endovascular intervention and help localize the disease and plan the procedure. The timing and need for revascularization are broadly related to the 3 main clinical presentations of claudication, critical limb ischemia, and acute limb ischemia. Many patients with claudication can be treated through exercise and medical therapy. Endovascular procedures are considered when these fail to improve quality of life and function. In contrast, critical limb ischemia and acute limb ischemia threaten the limb and require more urgent revascularization. In general, endovascular treatments have more excellent long-term durability for aortoiliac disease than femoral popliteal disease. Infrapopliteal revascularization is generally reserved for critical and acute limb ischemia. Balloon angioplasty and stenting are the mainstays of endovascular therapy. New well-tested innovations include drug-eluting stents and drug-coated balloons. Adjunctive devices for crossing chronic total occlusions or debulking plaque with atherectomy are less rigorously studied and have niche roles. Patients receiving endovascular procedures need a structured surveillance plan for follow-up care. This includes intensive treatment of cardiovascular risk factors to prevent myocardial infarction and stroke, which are the leading causes of death. Limb surveillance aims to identify restenosis and new disease beyond the intervened segments, both of which may jeopardize patency and lead to recurrent symptoms, functional impairment, or a threatened limb.
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Dr Rohit Agarwal is an interventional radiologist with an experience of 8 years in the field of diagnostic and interventional radiology. He received his training in the field of interventional radiology and endovascular sciences from Sir Gangaram Hospital, New Delhi, SGPGI, lucknow and Bach Mai Hospital, Hanoi. Dr. Rohit Agarwal is consultant in the department of interventional Radiology in Medanta hospital Lucknow with over 8 years of experience in Radiology and Interventional Radiology. He did his MBBS from KGMC, Lucknow followed by post graduation in Radiology from prestigious Dr RML Hospital and PGIMER New Delhi. After completing his training in Radiology he went for superspeciality training in the field of Interventional and vascular Radiology from prestigious Sir Gangaram Hospital, New Delhi and SGPGI, Lucknow.
