Conservative treatment comes before many procedures
Risk-factor treatment, smoking cessation, exercise therapy and appropriate medication are fundamental parts of PAD management. Revascularization is considered when symptoms remain substantially limiting or when limb viability is threatened, rather than simply because imaging shows a stenosis.
The anatomy determines the revascularization strategy
A vascular team needs to know where disease is located and how extensive it is before choosing balloon angioplasty, stenting, other endovascular devices, endarterectomy or bypass surgery.
- Duplex ultrasound
- CT or MR angiography when required
- Previous angiography and intervention reports
- Walking distance and symptom severity
- Presence of rest pain, ulcers or tissue loss
- Kidney function, diabetes and wound status
Endovascular treatment and bypass are not interchangeable packages
UKE describes endovascular techniques using vascular access, balloons, stents and other devices, while open surgery is still used for selected severe disease. Long lesions, occlusions, calcification, prior interventions, conduit availability and patient risk can all affect the preferred strategy.
Critical limb ischemia requires timely local assessment
Rest pain, non-healing ulcers, gangrene, sudden coldness or acute loss of blood flow can represent limb-threatening disease. These situations should not be managed as routine medical tourism and require prompt local vascular assessment.
Plan wound care and follow-up after revascularization
For patients with ulcers or diabetic foot problems, restoring blood flow is only one part of care. Wound treatment, infection management, footwear/off-loading, diabetes control and surveillance of the treated artery may all be necessary after discharge.
Official sources
Sources last checked 2026-08-29. Eligibility, device choice and vascular-center procedures can change; confirm the current plan directly with the treating team.
- Peripheral artery disease – endovascular and surgical treatment — University Medical Center Hamburg-Eppendorf (UKE) ↗
- Vascular Medicine – integrated vascular surgery, intervention and angiology — University Medical Center Hamburg-Eppendorf (UKE) ↗
- Vascular outpatient clinics — University Medical Center Hamburg-Eppendorf (UKE) ↗