Implications in the treatment of peripheral arterial disease: focussing on endovascular and non-invasive strategies

Peripheral arterial disease is an illness where the vascularisation of the lower extremities is compromised due to arterial sclerosis. This can cause pain in the lower extremities when the patient is exercising, or even when in rest. In a progressive stage, this might result in chronic ulceration or even amputations. To improve the vascularisation, patients are prescribed supervised exercise therapy. If this does not result in an improved walking distance without pain, an angioplasty can be considered. Unfortunately, neither intervention is perfect. The adherence to supervised exercise therapy is very low and therefore results are often disappointing. In case of angioplasty, nephrotoxic iodine contrast is used to visualize the arteries and localize the stenotic lesion. However, the use of this contrast medium is harmful to the kidneys, especially considering patient with peripheral arterial disease often have diminished renal function. This thesis investigates the behavioural determinants involved in poor adherence to supervised exercise therapy. Furthermore, it explores novel intervention techniques to abolish the use of nephrotoxic contrast or prevent its harmful nephrotoxic properties.