In-stent restenosis.

Endovascular arterial recanalization has become the mainstay therapy for peripheral arterial occlusive disease. Although immediate technical success is achieved in greater than 90% of cases, longer-term results continue to vary based on the clinical presentation, and the treated target lesion. In the current era, sustained patency can be expected following intervention in the carotid, coronary, renal, and iliac arteries. However, maintaining patency in the femoropopliteal and tibial arteries continues to be present a significant challenge. Endovascular intervention in the peripheral arteries is met with heavy complex plaque burdens, multiple serial stenoses and occlusions, sluggish blood flow, low mean and oscillatory shear stress, and repetitive axial, radial and torsional deformation that hinder its outcomes. In order to maximize the longevity of endovascular intervention, its therapeutic armamentarium has developed to include vessel preparation, drug delivery, and arterial scaffolding. Nevertheless, in the aggregate of real-world clinical practice, recurrence of stenosis still complicates up to 50% of all infrainguinal endovascular procedures after only one year. Unfortunately, this timeline is often insufficient to reliably address lifestyle limiting symptoms, heal a wound, or save a threatened extremity. The purpose of this review is to discuss the pathophysiology, incidence, risk factors, morphology and treatment of restenosis following peripheral endovascular intervention.