Current advancements in the care of peripheral arterial disease: modern approaches to medical, endovascular, and surgical treatment.

People with peripheral arterial disease (PAD) of the lower limbs are at very high risk of cardiovascular events and therefore the cornerstone of their management is medical therapy and behaviour modification to reduce that risk. The risk of limb loss (through major amputation) is low in people with asymptomatic PAD or intermittent claudication with only a few patients progressing to the most severe form of PAD: chronic limb threatening ischaemia. Supervised exercise therapy is effective in patients with intermittent claudication to improve their walking capacity and avoids the risks associated with revascularisation procedures to improve blood flow to the limb. Although some people with intermittent claudication might need revascularisation, it is overused in this group. Revascularisation of stenosed or occluded arteries can be done by open or endovascular surgery and is generally reserved for people with chronic limb threatening ischaemia who are at highest risk of limb loss because these interventions carry substantial peri-procedural risks and often have minimal durability. Innovative therapies to treat PAD focus on improving health-related quality of life, reducing limb loss, and improving survival but the disease remains challenging due to its impact on multiple arterial levels and in different organ systems (polyvascular disease).