PAD is not failing for lack of options — it is failing because the right options are too often used in isolation, too late, or not at all. This review shows where the strongest treatment signals truly are, from rivaroxaban-plus-aspirin and exercise therapy to IVUS-guided revascularization, and why real progress depends on combining them into one strategy.
Abstract: The aim of this paper is to synthesize current evidence regarding the risk factors, diagnostic screening tools, and therapeutic interventions for peripheral artery disease, with a focus on improving limb salvage and cardiovascular outcomes. The review utilises 3585 original studies with 35864537 total participants (topic deduplicated ΣN). The mapped evidence suggests that contemporary peripheral artery disease care is most consistently strengthened by intensive secondary prevention, structured exercise, and selective revascularization, with dual-pathway inhibition standing out as a prominent signal: low-dose rivaroxaban plus aspirin was associated with a 43% reduction in major adverse limb events and a 58% reduction in total vascular amputations in stable peripheral artery disease, while post-revascularization analyses showed hazard ratios of about 0.85 to 0.86 for ischemic event reduction. Across the broader treatment landscape, supervised and home-based exercise improved walking performance, cilostazol and statins supported symptom and event reduction, and drug-coated balloons, drug-eluting stents, intravascular lithotripsy, and intravascular ultrasound-guided intervention were repeatedly associated with better procedural or patency-related outcomes in selected anatomic settings. At the same time, the evidence map highlights that treatment benefit is strongly modified by diabetes mellitus, chronic kidney disease, frailty, bleeding risk, and major socioeconomic and sex-based disparities in access to guideline-directed care. Clinically, these findings support a multidisciplinary model in which aggressive medical therapy, exercise rehabilitation, and anatomy-specific revascularization are integrated rather than treated as competing strategies. Because much of the literature remains heterogeneous and a substantial share is observational, future research should prioritize pragmatic and phenotype-specific trials that clarify optimal antithrombotic selection, limb-specific effects of newer metabolic therapies, and implementation strategies that reduce undertreatment and inequity in peripheral artery disease care.
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Total Abstracts/Papers: 23731
Downloaded Abstracts/Papers: 10000
Included original and non-original Abstracts/Papers (all): 4452
Included original Abstracts/Papers (Vote counting by direction of effect): 3585
Reference Index (links used in paper): 350
Total participants (topic deduplicated ΣN): 35864537
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[3002] Life's Simple 7 and Risk of Peripheral Artery Disease: Results from the PREDIMED Study and an Updated Meta-Analysis. — https://doi.org/10.3390/nu17132058
[3011] Measuring walking impairment in patients with intermittent claudication: psychometric properties of the Walking Estimated-Limitation Calculated by History (WELCH) questionnaire. — https://doi.org/10.7717/peerj.12039
[3017] Acute Limb Ischemia and Outcomes With Vorapaxar in Patients With Peripheral Artery Disease: Results From the Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With Atherosclerosis-Thrombolysis in Myocardial Infarction 50 (TRA2°P-TIMI 50). — https://doi.org/10.1161/circulationaha.115.019355
[3065] Balloon-expandable cobalt chromium stent versus self-expandable nitinol stent for the Atherosclerotic Iliac Arterial Disease (SENS-ILIAC Trial) Trial: a randomized controlled trial. — https://doi.org/10.1007/s00380-024-02431-4
[3082] 12-Month Results From the First-in-Human Randomized Study of the Ranger Paclitaxel-Coated Balloon for Femoropopliteal Treatment. — https://doi.org/10.1016/j.jcin.2018.01.276
[3096] Optimal cut-off value of preprocedural geriatric nutritional risk index for predicting the clinical outcomes of patients undergoing endovascular revascularization for peripheral artery disease. — https://doi.org/10.1016/j.jjcc.2020.05.015
[3097] Development and evaluation of a prediction model for peripheral artery disease-related major adverse limb events using novel biomarker data. — https://doi.org/10.1016/j.jvs.2024.03.450
[3099] Outcomes of endovascular treatment for infrapopliteal peripheral artery disease based on the updated TASC II classification. — https://doi.org/10.1177/1358863x20967091
[3131] Selecting Treatments for Peripheral Artery Disease: Differences Between Registry and a Randomized Controlled Trial Population. — https://doi.org/10.1016/j.jss.2025.02.040
[3136] Remnant cholesterol is independently asssociated with an increased risk of peripheral artery disease in type 2 diabetic patients. — https://doi.org/10.3389/fendo.2023.1111152
[3142] Step Count Accuracy of the Life Plus Connected Watch at Different Localizations and Speeds in Healthy Adults, Patients With Cardiovascular Disease, and Patients With Peripheral Artery Disease: Step Count Validation Study in Laboratory Settings. — https://doi.org/10.2196/58964
[3161] Clinical characteristics and response to supervised exercise therapy of people with lower extremity peripheral artery disease. — https://doi.org/10.1016/j.jvs.2020.04.498
[3206] Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry. — https://doi.org/10.1093/eurheartj/ehu080
[3211] Endovascular Treatment of Femoro-Popliteal Disease with the Supera Stent: A Single Center Experience. — https://doi.org/10.3390/jcm14051704
[3220] Long-term outcomes following endovascular and surgical revascularization for peripheral artery disease: a propensity score-matched analysis. — https://doi.org/10.1093/eurheartj/ehab116
[3243] Sustained Effectiveness of Cilostazol After Endovascular Treatment of Femoropopliteal Lesions: Midterm Follow-up From the Sufficient Treatment of Peripheral Intervention by Cilostazol (STOP-IC) Study. — https://doi.org/10.1177/1526602818771358
[3285] Benefit of Semaglutide in Symptomatic Peripheral Artery Disease by Baseline Type 2 Diabetes Characteristics: Insights From STRIDE, a Randomized, Placebo-Controlled, Double-Blind Trial. — https://doi.org/10.2337/dc25-1082
[3295] Machine Learning Approach to Predict In-Hospital Mortality in Patients Admitted for Peripheral Artery Disease in the United States. — https://doi.org/10.1161/jaha.122.026987
[3326] Performance and usability testing of an automated tool for detection of peripheral artery disease using electronic health records. — https://doi.org/10.1038/s41598-022-17180-5
[3334] Adverse Events After Atherectomy: Analyzing Long-Term Outcomes of Endovascular Lower Extremity Revascularization Techniques. — https://doi.org/10.1161/jaha.119.012081
[3341] Tailored Physiotherapy Combined With Exercises for Enhanced Recovery Post-Below-Knee Amputation in a Diabetic Patient With Peripheral Artery Disease (PAD): A Case Report. — https://doi.org/10.7759/cureus.69781
[3362] Intravascular Lithotripsy for Peripheral Artery Calcification: Mid-term Outcomes From the Randomized Disrupt PAD III Trial. — https://doi.org/10.1016/j.jscai.2022.100341
[3373] Impact of guideline-directed medical therapy on 5-year mortality in patients with newly diagnosed peripheral artery disease. — https://doi.org/10.1016/j.jvs.2023.08.103
[3398] Lipoprotein(a) and risk of coronary, cerebrovascular, and peripheral artery disease: the EPIC-Norfolk prospective population study. — https://doi.org/10.1161/atvbaha.112.255521
[3423] Complex relationship between low albumin level and poor outcome after lower extremity procedures for peripheral artery disease. — https://doi.org/10.1016/j.jvs.2020.04.524
[3424] Heparin-bonded covered stents versus bare-metal stents for complex femoropopliteal artery lesions: the randomized VIASTAR trial (Viabahn endoprosthesis with PROPATEN bioactive surface [VIA] versus bare nitinol stent in the treatment of long lesions in superficial femoral artery occlusive disease). — https://doi.org/10.1016/j.jacc.2013.05.079
[3426] One-Year Clinical Outcomes following Implantation of Innova Self-Expanding Nitinol Stents in Patients with Peripheral Artery Diseases Presenting Femoropopliteal Artery Lesions. — https://doi.org/10.5551/jat.47399
[3440] Body mass-normalized moderate dose of dietary nitrate intake improves endothelial function and walking capacity in patients with peripheral artery disease. — https://doi.org/10.1152/ajpregu.00121.2021
[3449] Identifying predictors of durable treatment response among patients with claudication: A secondary analysis of the CLEVER trial. — https://doi.org/10.1177/1358863x251333932
[3471] Clinical Outcomes Based on High Bleeding Risk in Patients With Lower Extremity Peripheral Artery Disease Who Have Undergone Endovascular Therapy. — https://doi.org/10.1177/15266028231176953
[3512] Safety and Effectiveness of Endovascular Therapy for the Treatment of Peripheral Artery Disease in Patients with and without Diabetes Mellitus. — https://doi.org/10.1177/00033197221075857
[3518] Focus group study of factors relevant to treatment decisions and experiences among patients with symptomatic peripheral artery disease. — https://doi.org/10.1016/j.jvs.2022.06.023
[3537] The Geriatric Nutritional Risk Index Predicts Long-Term Survival and Cardiovascular or Limb Events in Peripheral Arterial Disease. — https://doi.org/10.5551/jat.49767
[3539] Sex Disparities in Long-Term Mortality after Paclitaxel Exposure in Patients with Peripheral Artery Disease: A Nationwide Claims-Based Cohort Study. — https://doi.org/10.3390/jcm10132978
[3543] Comparison between intermittent claudication chronic limb-threatening ischemia in peripheral arterial disease: a retrospective multicenter cohort study. — https://doi.org/10.4174/astr.2024.106.6.344
[3560] Major Limb Outcomes Following Lower Extremity Endovascular Revascularization in Patients With and Without Diabetes Mellitus. — https://doi.org/10.1177/1526602817705135
[3561] The Impact of Intravascular Ultrasound on Femoropopliteal Artery Endovascular Interventions: A Randomized Controlled Trial. — https://doi.org/10.1016/j.jcin.2022.01.001
[3572] Biomarkers of Neutrophil Activation in Patients with Symptomatic Chronic Peripheral Artery Disease Predict Worse Cardiovascular Outcome. — https://doi.org/10.3390/biomedicines11030866
[3580] Intravascular Ultrasound Guidance During Peripheral Vascular Interventions: Long-term Clinical Outcomes and Costs From the Japanese Perspective. — https://doi.org/10.1177/15266028231182382
[3597] Changes in exercise capacity and risk of all-cause mortality in patients with peripheral artery disease: a 10-year retrospective cohort study. — https://doi.org/10.1007/s11739-019-02176-3
[3612] Simultaneous Hybrid Operation Common Femoral Endarterectomy and Endovascular Treatment in Multilevel Peripheral Arterial Disease with Critical Limb Ischemia. — https://doi.org/10.1007/s12262-016-1570-2
[3613] Exploring the Relationship Between SVS WIfI and IWGDF Scoring Systems and Reamputation Risk in Patients With Diabetic Foot and Peripheral Artery Disease. — https://doi.org/10.1177/15347346251333835
[3617] Adverse cardiovascular, limb, and renal outcomes in patients with diabetes after peripheral artery disease revascularization treated with sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors. — https://doi.org/10.1186/s13098-023-00982-6
[3631] Investigating the Prognostic Potential of Plasma ST2 in Patients with Peripheral Artery Disease: Identification and Evaluation. — https://doi.org/10.3390/proteomes12030024
[3638] Three-Year Outcomes From the LIBERTY 360 Study of Endovascular Interventions for Peripheral Artery Disease Stratified by Rutherford Category. — https://doi.org/10.1177/1526602820962972
[3646] Artificial intelligence for the evaluation of peripheral artery disease using arterial Doppler waveforms to predict abnormal ankle-brachial index. — https://doi.org/10.1177/1358863x221094082
[3677] Liraglutide improves peripheral perfusion and markers of angiogenesis and inflammation in people with type 2 diabetes and peripheral artery disease: An 18-month follow-up of a randomized clinical trial. — https://doi.org/10.1111/dom.16419
[3723] Assessing wear time and perceptions of wearing an ankle foot orthosis in patients with peripheral artery disease. — https://doi.org/10.1002/pmrj.12829
[3728] Platelet RNA Biomarker of Ticagrelor-Responsive Genes Is Associated With Platelet Function and Cardiovascular Events. — https://doi.org/10.1161/atvbaha.123.319759
[3755] Cracking the Calcium Barrier: Intravascular Lithotripsy for Peripheral Arterial Disease-1-year Outcomes From 50 Procedures in a Singapore Tertiary Hospital. — https://doi.org/10.1177/15266028251399111
[3780] Cilostazol reduces dry eye symptoms and improve walking distance in patients with peripheral artery disease. — https://doi.org/10.7417/ct.2019.2160
[3813] Angiographic and Clinical Outcomes After Treatment of Femoro-Popliteal Lesions with a Novel Paclitaxel-Matrix-Coated Balloon Catheter. — https://doi.org/10.1007/s00270-017-1713-2
[3899] Antithrombotic therapy following lower extremity endovascular revascularization: The results of a survey of vascular specialists. — https://doi.org/10.1016/j.jvsvi.2024.100153
[3955] Autologous Peripheral Blood Mononuclear Cells in Patients with Small Artery Disease and Diabetic Foot Ulcers: Efficacy, Safety, and Economic Evaluation. — https://doi.org/10.3390/jcm12124148
[3966] Interpretable Machine Learning for the Prediction of Amputation Risk Following Lower Extremity Infrainguinal Endovascular Interventions for Peripheral Arterial Disease. — https://doi.org/10.1007/s00270-022-03111-4
[3983] Polyvascular Disease and Risk of Major Adverse Cardiovascular Events in Peripheral Artery Disease: A Secondary Analysis of the EUCLID Trial. — https://doi.org/10.1001/jamanetworkopen.2018.5239
[3996] ApoA-I Nanotherapy Rescues Postischemic Vascular Maladaptation by Modulating Endothelial Cell and Macrophage Phenotypes in Type 2 Diabetic Mice. — https://doi.org/10.1161/atvbaha.122.318196
[4001] Twelve-month safety and effectiveness of TCD-17187 drug-coated balloon for the treatment of atherosclerotic lesions in the superficial femoral and proximal popliteal artery. — https://doi.org/10.1002/ccd.30408
[4088] Clinical outcomes of a balloon-expandable stent for symptomatic obstructions of the subclavian or innominate arteries. — https://doi.org/10.1024/0301-1526/a001092
[4116] The incidence and significance of delayed bleeding events after lower extremity revascularization in patients with advanced peripheral arterial disease. — https://doi.org/10.1016/j.jvs.2025.03.394
[4134] Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study. — https://doi.org/10.3390/ijerph18179348
[4153] Telmisartan improves absolute walking distance and endothelial function in patients with peripheral artery disease. — https://doi.org/10.1007/s00392-010-0184-0
[4157] Three-Year Outcomes of Orbital Atherectomy for the Endovascular Treatment of Infrainguinal Claudication or Chronic Limb-Threatening Ischemia. — https://doi.org/10.1177/1526602820935611
[4174] Solid state, pulsed-wave 355 nm UV laser atherectomy debulking in the treatment of infrainguinal peripheral arterial disease: The Pathfinder Registry. — https://doi.org/10.1002/ccd.31023
[4193] The Impact of Chronic Kidney Disease on Amputation and Death Rates in Patients with Peripheral Artery Disease in the United States. — https://doi.org/10.1016/j.jvir.2025.03.013
[4234] Low-Dose Paclitaxel-Coated Versus Uncoated Percutaneous Transluminal Balloon Angioplasty for Femoropopliteal Peripheral Artery Disease: One-Year Results of the ILLUMENATE European Randomized Clinical Trial (Randomized Trial of a Novel Paclitaxel-Coated Percutaneous Angioplasty Balloon). — https://doi.org/10.1161/circulationaha.116.026493
[4240] Geriatric Nutritional Risk Index as a Predictor of Major Adverse Limb Events in Older Patients With Peripheral Artery Disease: A Prospective Cohort Study. — https://doi.org/10.1111/jocn.17859
[4250] Effect of arm-ergometry versus treadmill supervised exercise on health-related quality of life and mental health in patients with peripheral artery disease: secondary outcomes from the ARMEX trial. — https://doi.org/10.1186/s41687-025-00847-8
[4251] The Identification and Evaluation of Interleukin-7 as a Myokine Biomarker for Peripheral Artery Disease Prognosis. — https://doi.org/10.3390/jcm13123583
[4258] The Nevada peripheral artery disease screening effort in a Medicare Advantage population and subsequent mortality and major adverse cardiovascular event risk. — https://doi.org/10.1016/j.jvs.2022.01.134
[4279] A group-mediated, home-based physical activity intervention for patients with peripheral artery disease: effects on social and psychological function. — https://doi.org/10.1186/1479-5876-12-29
[4290] Three Months of Wearing an Ankle Foot Orthosis Improves the Spatiotemporal Gait Characteristics in Patients With Peripheral Artery Disease. — https://doi.org/10.1123/jab.2024-0083
[4292] A Platelet Reactivity ExpreSsion Score derived from patients with peripheral artery disease predicts cardiovascular risk. — https://doi.org/10.1038/s41467-024-50994-7
[4387] A retrospective analysis on optimal medical therapy for patients with symptomatic lower extremity peripheral artery disease: a French observational study. — https://doi.org/10.1186/s12872-024-04289-w
[4399] Vascular Quality Initiative assessment of compliance with Society for Vascular Surgery Practice Guidelines for the endovascular management of claudication. — https://doi.org/10.1016/j.jvs.2025.01.007
[4402] The relative importance of systolic versus diastolic blood pressure control and incident symptomatic peripheral artery disease in women. — https://doi.org/10.1177/1358863x11413166
