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Endovascular procedures rely on catheters to increase blood flow to the legs. The catheter is usually introduced into the artery through the groin, where it is advanced through the vessel until it has reached the narrowed portion. A variety of procedures can be done with different types of catheters, including:
- Angioplasty. One of the most common endovascular procedures for the treatment of lower extremity peripheral arterial disease (PAD). This technique uses a balloon-tipped catheter, which is positioned at the site of the blockage. The balloon is then expanded. This breaks the atherosclerotic plaque blocking the artery and pushes the plaque against the artery wall, creating a larger opening in the artery through which blood can flow. This procedure is similar to the one used in blocked coronary arteries in the heart.
- Stenting. Stents are sometimes used in conjunction with angioplasty. A stent is an expandable wire-mesh tube that can be deployed from a catheter at the location of the blockage. The stent provides ongoing mechanical support to open the vessel and hold the plaque back. Two recent studies have suggested that stents may have better long-term results that angioplasty alone. Some stents have a drug coating (drug eluting stents) that help prevent an artery from re-narrowing (restenosis) and reduce the risk of blood clots that sometimes form because of the stent. Drug coated stents are not available for lower extremity, only coronary artery disease. All peripheral stents are bare metal. Drug coated stents are under investigation.
- Other catheter-based procedures. Sometimes the material blocking the artery is mainly clotted blood (a thrombus). In these cases there is a variety of catheters that can be used. Some use water jets to remove the clot as the catheter is passed through it. This is called thrombectomy. Other catheters are made to deliver drugs that speed the body’s natural ability to dissolve clots. This is called thrombolysis. There are still other catheters that can remove plaque, called atherectomy catheters. Atherectomy catheters are being used more often in recent years. However, currently, there is no evidence that these catheter treatments are superior to angioplasty and stent.
Catheter-based procedures are often the first method of invasive treatment used for patients with lower extremity PAD. They can usually be done on an outpatient basis and require only local anesthetic. Patients can usually return to their normal activity within one to two days.
The downside of catheter-based procedures is relatively high recurrence rates. This is because disease of the lower extremities frequently extends over long segments of the leg arteries, and these long segments often develop new blockages after angioplasty or stenting. For that reason it is important to monitor the treated arteries with ultrasound regularly following the treatment so that any recurrence can be detected early and treated easily before more extensive surgery or other treatments are required. | 
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