Can endovascular therapy of infrainguinal disease for claudication be justified?

Traditionally, patients with exercise-induced lower extremity ischemia (claudicants) have been treated conservatively. It is important to remember that this is not because the pain of claudication is less important than pain due to other problems, but because the only 'cure', operative bypass, has been judged too invasive by both patient and physician. Recent data suggest that endovascular treatment of atherosclerotic disease below the inguinal ligament yields good short-term results, with low periprocedural morbidity and does not compromise future surgical alternatives in the long-term. If this approach is to be used as nonoperative treatment for the pain of claudication, however, the authors suggest that long-term success may be less important than the absolute minimization of short-term and periprocedural risk. The authors believe that given the results of modern endovascular therapy it is increasingly less acceptable to tell claudicants to live with their pain if conservative therapy fails. The option of endovascular treatment for infrainguinal atherosclerotic disease should be discussed with every patient whose claudication is significant, and considered as a treatment option in place of continued pain. This approach should be judged against conservative therapy for claudication, not against surgical bypass for limb threat.