Fundamentals of PTA and stenting for peripheral arterial disease (2026)

Description

Authors: S. de Boer and F. Fanelli

Reviewer: S. Duvnjak, D. Filippiadis, A. Gjoreski, R. Iezzi, S. Punamiya, R. Uberoi and D. Vorwerk

This course corresponds to chapter 2.2.1.1.1 Peripheral arterial disease in the European Curriculum and Syllabus for Interventional Radiology.

Abstract

The prevalence of peripheral arterial occlusive disease (PAOD) was estimated by the Global Peripheral Artery Disease Study to be around 237 million PAOD cases worldwide in 2015. Compared to 2010, this is a relative increase of 17%. If asymptomatic patients are also taken into consideration by use of non-invasive testing, the prevalence of the disease is estimated to be 3% in middle-aged patients, increasing to 20% in patients >70 years of age. About one-third of PAOD lesions in the body affect the aorto-iliac segment. The most common clinical manifestation of PAOD is intermittent claudication (IC) involving the upper thigh, often in combination with lower limb claudication. The worst clinical manifestation of PAOD is chronic limb threatening ischemia (CLTI) which is a limb- and life-threatening condition with a yearly incidence of around 220 new cases per one million population. Patients presenting with CLTI usually have multisegmental disease with involvement of the infrainguinal arteries. Typical below-the-knee (BTK) diabetic arterial disease is characterized by long, multilevel disease involving all three infrapopliteal vessels.

In symptomatic patients with aorto-iliac stenosis/occlusion and with IC, and especially after failed supervised exercise therapy, percutaneous endovascular therapy can offer minimally invasive treatment with reduced perioperative morbidity and mortality and reduced in-hospital stay compared to open surgery. Percutaneous transluminal angioplasty (PTA) and stenting is the routine endovascular treatment of choice in most patients with IC or CLTI with involvement of the aorto-iliac segment with stenotic/occlusive disease. Usually, IC patients with infraligamental diseases are not primarily treated invasively, neither with endovascular nor with open surgery. For these patients, supervised walking exercise is often the first choice of therapy. To date, several new technologies, such as bare metal stents made from nitinol, drug-coated balloons (DCB), drug-eluting stents (DES), covered stents, and percutaneous atherectomy have emerged with the aim to improve long-term patency outcomes following endovascular treatment.

Learning objectives

• To understand the causes of peripheral ischaemia and recognise the risk factors for development and progression of PAOD.
• To know the arterial anatomy and recognise the collateral pathways for patients with PAOD.
• To describe the specific clinical features and categorise IC and CLTI according to current systems i.e. SVS/ISVS/Rutherford/Fontaine and Wound (W), Ischemia (I) and Foot infection (fI) WIfI classifications.
• To learn clinical presentation, vascular examinations, and the difference between IC and CTLI. Furthermore, to know how to identify ideal patients for treatment.
• To know the specific angiographic patterns and anatomical levels of disease involvement in patients with IC and CLTI with a special focus on diabetes-related PAOD.
• To understand strategies for imaging patients with PAOD including DSA, MRA, CTA, and colour-doppler ultrasonography.
• To learn how to plan optimal vascular access for percutaneous endovascular treatment of PAOD.
• To learn correct selection and use of equipment including:
  • Guidewires
  • Catheters
  • Sheaths
  • Re-entry devices
  • Balloons
  • Atherectomy devices
  • Stents and stent-grafts
• To improve technical competence in the performance of peripheral vascular interventions including:
  • Crossing stenosis with selective catheters and guidewires
  • Recanalization techniques of total occlusions including subintimal recanalization and use of re-entry devices
  • Balloon angioplasty and stent placement including DCBs and DESs
  • Percutaneous atherectomy
  • Catheter-directed thrombolysis, percutaneous aspiration, and mechanical thrombectomy
  • Management of complications

Further information

This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for Interventional Radiology and corresponds to chapter 2.2.1.1.1 Peripheral arterial disease.

The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around one and half hour and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 1.5 European CME credits (ECMEC). Please note that this course will be taken offline on February 18, 2031.

The enrolment period of this course is linked to the validity of the All-Access Pass.

Release date: February 2026