Abstract
Recently, end vascular therapies (EVT) has been widely performed for the peripheral artery disease (PAD) patients. In the femoro-popliteal lesions, TASC II guideline recommend to perform bypass surgery for the type C, D complex lesions, because some clinical studies showed that primary patency of EVT for these complex lesions were lower than bypass surgery. Now, EVT for these complex lesions has achieved more than 90% of initial success rate. However, insufficient primary patency rate is still a hurdle. Repeat EVT maintains acceptable secondary patency. EVT is often necessary for high risk patients of operation who have coronary artery disease or cerebral vascular disease, especially when patients have critical limb ischemia. Whenever we perform EVT for these patients, we have to try to get initial success without any complications, and we have to chose effective techniques, for example, bi-directional approach, echo guide wiring and distal protection. In the future, if drug eluting stent will be available in Japan, we can serve less invasive and more effective EVT for PAD patients.