Lower leg revascularization Clinical outcomes of invasive femoropopliteal interventions for peripheral arterial disease

Peripheral arterial disease (PAD) is an increasingly prevalent vascular condition that impairs mobility and quality of life, often requiring invasive interventions such as endovascular therapy or femoropopliteal bypass surgery. This thesis investigates the clinical, technical, and economic outcomes of invasive treatments for lower extremity PAD, using data from a large patient cohort treated at a major teaching hospital.It is found that, in patients with medium-length femoropopliteal lesions, endovascular therapy and bypass surgery yield comparable patency rates. However, endovascular therapy is associated with fewer complications, shorter hospital stays, and significantly lower costs, making it a cost-effective alternative in this subgroup. These findings support an endovascular-first approach. Additionally, an analysis comparing stent placement with plain percutaneous transluminal angioplasty (PTA) in superficial femoral artery disease reveals no significant differences in patency, re-intervention, or amputation rates, supporting a selective stenting strategy.The thesis further explores the correlation between the ankle-brachial index (ABI) and patient-reported outcome measures (PROMs), using the Dutch VQ-6 questionnaire. Results show that ABI alone is insufficient to assess treatment success, underscoring the added value of PROMs in evaluating vascular interventions.Lastly, a systematic review comparing autologous saphenous vein (ASV) grafts with prosthetic conduits in femoropopliteal bypass for intermittent claudication demonstrates similar short-term outcomes, with ASV showing superior long-term patency.In conclusion, this thesis advocates for a patient-centered approach to the invasive management of PAD, integrating clinical outcomes, patient experience, and economic considerations into treatment decision-making.