Combination therapy for complex peripheral artery disease: the evidence for combining mechanical revascularization with anti-restenotic drug delivery systems.

The management of complex, lower-extremity peripheral artery disease remains a difficult challenge, with ample room for improvement in the results seen with current generation devices. Therapies which use a combination of multiple devices for their mechanical and anti-restenotic properties may be advantageous, and offer an opportunity to improve the durability of revascularization through optimizing and individualizing care. Combination therapy typically utilizes drug delivery devices in addition to stents and atherectomy to achieve improved results. However, there is a paucity of high-level evidence with which to direct treatment, with many different forms of combination therapy under investigation and little clinical research coordination. Herein we seek to describe and evaluate the growing number of options for combination treatment in this challenging disease.