Lower limb peripheral arterial diseases: diagnosis, management and the effect of pedal arch reconstruction on the overall outcomes

Sibasankar Dalai, Aravind V. Datla, Sreekanth Matcha, Noopur Parikh, Swetha N. Rongali


Peripheral arterial diseases (PAD) are a significant cause of morbidity and limb loss. PAD is estimated to affect 237 million people worldwide. Atherosclerosis accounts for 95% of the cases of PAD. The progression of atherosclerosis gradually narrows the vascular lumen and leads to ischemia. Of the several risk factors implicated in PAD, smoking is most significant. The diagnosis of PAD requires a high index of suspicion. Over 50% of the patients are asymptomatic. A sizeable portion attributes their mild to moderate symptoms to general ageing rather than PAD and fails to seek medical advice. Claudication is a classical symptom of PAD. With the progression of the disease, rest pain, ulcerations, or gangrene can develop. PAD can be diagnosed by thorough history-taking, detailed physical examination (including objective measures like an ankle-brachial index) and imaging modalities such as duplex ultrasonography, contrast-enhanced ultrasound, magnetic resonance angiography, computed tomography angiography, and digital subtraction angiogram. Early identification and risk factor modification are crucial for improving the outcomes in PAD patients. Treatment strategies include lifestyle modifications, pharmacotherapy and revascularisation (surgical or endovascular). With the recent technological advances, coupled with its minimally invasive nature, the popularity of Endovascular therapy (ET) is increasing. However, the procedure of pedal arch reconstruction and the role ET can play in improving the outcomes of patients with poor pedal vascularity is still debated. The aim of the study was to find answer some of the queries on the topic of ET for the management of PAD of the lower limbs.


Peripheral arterial disease, Critical limb ischemia, Endovascular therapy, Below knee angioplasty, Below ankle angioplasty, Pedal arch reconstruction

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