Pathophysiology and Therapeutic Advances in Peripheral Vascular Diseases: An Angiology Perspective

Peripheral vascular diseases (PVDs) encompass a broad spectrum of disorders affecting the arteries, veins, and microcirculation and continue to represent a significant global clinical and socioeconomic burden. These conditions often remain asymptomatic in their early stages and are frequently associated with systemic comorbidities such as diabetes mellitus, hypertension, and dyslipidemia, which complicate disease management and worsen prognosis. From an angiology perspective, a comprehensive understanding of the underlying vascular mechanisms is essential for improving diagnostic accuracy and therapeutic outcomes. This review summarizes the key pathophysiological mechanisms involved in PVDs, including endothelial dysfunction, impaired nitric oxide signaling, chronic inflammation, oxidative stress, thrombosis, and vascular remodeling. These interrelated processes collectively reduce blood flow, promote tissue ischemia, and accelerate progressive vascular damage. The contribution of major risk factors to disease initiation and progression is also discussed to emphasize the multifactorial nature of PVDs. Recent advances in diagnostic strategies, including clinical assessment tools, functional indices, imaging modalities, and emerging biomarkers, are highlighted to illustrate improvements in early detection and disease monitoring. Established therapeutic approaches, such as pharmacological management and endovascular or surgical revascularization, are critically examined alongside their long-term limitations. Special emphasis is placed on emerging angiology-based therapies, including mechanism-driven pharmacological interventions, endothelial-protective strategies, and novel approaches targeting inflammation and thrombosis. Finally, ongoing translational challenges and future directions are discussed, underscoring the growing importance of personalized, pathophysiology-guided treatment strategies in PVDs.