Peripheral artery disease (PAD) of the lower extremities, which poses a major challenge in the field of global public health, has seen a rising trend in its incidence and disability rate year by year. With the continuous innovation of new diagnostic techniques, imaging evaluation methods, and treatment strategies, profound changes have taken place in the diagnosis and treatment paradigm in this field. Based on the “European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication” issued by the European Society for Vascular Surgery in 2024, we systematically reviewed the relevant international guidelines in recent years and conducted horizontal comparisons. Combining with the latest clinical research evidence, we conducted an in-depth analysis from the perspective of evidence-based medicine on the strategic evolution, technical key point updates, and clinical evidence levels of endovascular treatment for lower extremity PAD. The aim is to provide an evidence-based medical basis for clinical decision-making.
This review systematically elaborates on the application of innovative devices and combined techniques for the endovascular treatment of lower extremity arterial calcified lesions, focusing on their use tailored to the depth of calcification. It details the technical principles and current application status of four atherectomy techniques (directional, rotational, orbital, and laser) targeted at intimal calcification. Furthermore, it provides an in-depth discussion on the mechanism of action and clinical evidence for intravascular lithotripsy (IVL) as a transformative technology capable of addressing deep medial layer calcification. The review also highlights the advances and value of combining intravascular imaging techniques, such as optical coherence tomography, with atherectomy for precision therapy. It shows that the application of these various innovative devices and combined techniques provides effective treatment options for lower extremity arterial calcified lesions. However, future research should focus on personalized treatment strategy selection, optimization of IVL technology, and long-term efficacy validation of new devices.