Restenosis after endovascular revascularization in peripheral artery disease

Abstract. Endovascular revascularization (EVR) plays a leading role in the therapy of peripheral artery disease. The acute success rates of EVR in all anatomic territories and of all TASC lesions are excellent (> 95%). However, the occurrence of restenoses after EVR such as percutaneous transluminal angioplasty and particularly after stenting, poses a substantial limitation to the success of the procedure. Influenced by patient’s comorbidities, the severity of arteriosclerotic disease, lesion length and morphology as well as the techniques and devices used for EVR, the long-term outcome of EVR deteriorates markedly from the aortoiliac to the infrapopliteal segments of the lower limbs. The development of drug-coated balloons and drug-eluting stents reduced the occurrence of restenosis leading to considerably improved primary patency rates in the femoropopliteal segments. This review aims to provide an overview about the underlying mechanisms and current relevance of the various options in the field of EVR with regard to the rate of restenosis.