The Future of Treatment Models in Peripheral Artery Disease: Surgical and Endovascular Approaches

Peripheral artery disease (PAD) affects over 200 million people worldwide, leading to significant morbidity and mortality. Treatment strategies have evolved from traditional surgical revascularization to minimally invasive endovascular techniques. Recently, hybrid procedures combining surgical and endovascular approaches have emerged as a promising alternative to optimize patient outcomes. This review compares the efficacy, benefits, and limitations of these treatment modalities in PAD management. A comprehensive analysis of recent randomized controlled trials, cohort studies, and systematic reviews was conducted using PubMed, Scopus, and Web of Science. Key metrics, including patency rates, complication profiles, amputation-free survival, and patient-reported outcomes, were evaluated. Findings suggest that surgical revascularization remains the gold standard for complex PAD cases due to superior long-term patency, despite higher perioperative risks. Endovascular interventions, such as angioplasty and stenting, offer lower short-term complications and faster recovery but are associated with higher restenosis rates. Hybrid procedures provide an alternative for high-risk patients and complex lesions, integrating the advantages of both techniques. Technological advancements, including drug-coated devices and precision imaging, continue to refine treatment outcomes. The choice of optimal PAD treatment depends on lesion complexity, patient comorbidities, and durability requirements. While surgical approaches provide long-lasting results, endovascular techniques offer less invasive solutions with lower immediate risks. Hybrid strategies bridge these approaches, improving outcomes in select cases. Future research should focus on long-term comparative studies and personalized treatment models to enhance clinical decision-making in PAD management.