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\begin{document}

             \author[1]{Reza Omidi  Varmezani}

             \affil[1]{  Spital BAlach- ZArich}

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\date{\small \em Received: 9 April 2015 Accepted: 1 May 2015 Published: 15 May 2015}

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\begin{abstract}
        


Introduction-Peripheral arterial disease is one of the most prevalent conditions, and it frequently associated with an increased risk of vascular disease in other parts of the body and substantial functional limitation. The initial disease process results in peripheral arterial disfunction causes turbulent flow in the arteries supplying the muscles of the lower extremities. Impaired endothelial function and limited blood flow results in an oxygen supply-demand mismatch.Early and adequate diagnosis is important for improving the patient`s quality of life and for reducing the risk of secondary vascular attacks. The presence of critical ischemia indicates the need for prompt revascularization because of high risk of limb amputation.In the healthy condition is ABI-index more than 0.90, whereas in PAD is less than 0.90 at rest with a further decrease after exercise.

\end{abstract}


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\let\tabcellsep& 	 	 		 
\section[{Peripheral Emergencies}]{Peripheral Emergencies}\par
eripheral arterial disease is one of the most prevalent conditions, and it frequently associated with an increased risk of vascular disease in other parts of the body and substantial functional limitation. The initial disease process results in peripheral arterial disfunction causes turbulent flow in the arteries supplying the muscles of the lower extremities. Impaired endothelial function and limited blood flow results in an oxygen supply-demand mismatch.\par
Early and adequate diagnosis is important for improving the patient`s quality of life and for reducing the risk of secondary vascular attacks. The presence of critical ischemia indicates the need for prompt revascularization because of high risk of limb amputation.\par
In the healthy condition is ABI-index more than 0.90, whereas in PAD is less than 0.90 at rest with a further decrease after exercise. 
\section[{II.}]{II.} 
\section[{Embryology}]{Embryology}\par
During the first 20 days of development, the human embryo has no cardiovascular structure. Over the next month, the heart and great vessels complete their development and look very much like they will at full gestation.\par
The digits arising from limb buds during this time  {\ref (8 weeks)}. The limb buds are supplies of the intersegment arteries, which arise from the aorta.\par
The vascular patterns change as the limbs develop, chiefly by angiogenesis.\par
In the thigh the primary axial artery is represented by the deep artery of the thigh (profund femoris artery).\par
In the leg, the anterior and posterior tibial arteries represent the primeral axial artery. 
\section[{III.}]{III.} 
\section[{Arteries of the Lower Extremities}]{Arteries of the Lower Extremities}\par
The common iliac arteries form the terminal bifurcation of the abdominal aorta approximately at the level of the fourth vertebral body (Fig. \hyperref[fig_1]{2}). The internal iliac artery arises from the medial aspect of the bifurcation of the common iliac artery.  {\ref (Heuser)} The common femoral artery is the continuation of the external iliac artery after it passes through the inguinal canal. The common femoral artery gives rise to the superficial circumflex iliac artery and the pudendal branches. The common femoral artery then bifurcates into the superficial femoral artery and the arteria profunda femoris (profunda). The femoral profundaartery comes off posterolaterally, and thus the femoral bifurcation is best seen angiographically with a 30° RAO or LAO view. The superficial femoral artery courses along the medial aspect of the thigh and continues on as the popliteal artery when it exits the adductor canal via the adductor hiatus. Prior to passing through the adductor canal, it gives rise to the superior genicular artery. It provides the superior, middle, and inferior genicular arteries, which have anastomoses with genicular branches from the superficial femoral and femoral profunda arteries. The popliteal artery continues below the knee until it bifurcates into the anterior tibial (lateral take off) and tibioperoneal trunk, which subsequently bifurcates into the peroneal artery and the posterior tibial artery, which is the medial-most artery. The anterior tibial artery passes between the tibia and fibula to run anterior to the interosseous membrane and eventually forms the arteria dorsalis pedis. (Heuser)  IV. 
\section[{Introduction}]{Introduction} 
\section[{Structure of Arteries}]{Structure of Arteries}\par
The big arteries have three layers, innermost provide a selectively permeable barrier. The middle layers strengthen the vessel and provide vasomotion (vasodilatation and vasoconstriction). The outermost layer provie passage for vasa vasorum (vessels of the vessels), protection and anchoring.\par
Because of this construction have the arteries unique pathology (for example aging process or dissection). Almost all arterial diseases are associated with lumen changes and therefore hemodynamic changes. 
\section[{Tunica media}]{Tunica media} 
\section[{Tunica adventitia Elastic tissue Tunica intima}]{Tunica adventitia Elastic tissue Tunica intima}\par
Peripheral arterial disease classification-Dissections / (pseudo) Aneurysm -Occlusive disease (Arteriosclerosis) -Congenital abnormalities -Trauma -Compression Syndromes -Tumors ? Primary ? Secondary V. 
\section[{Aneurysma a) Femoral Pseudoaneurysma}]{Aneurysma a) Femoral Pseudoaneurysma}\par
Although true aneurysms involves all three layers of the wall of an artery (intima, media and adventitia), false aneurysms or pseudoaneurysms are regarded as either a blood leaking collection (after a rupture) out of an artery or vain, but limited adjacent to the vessel by the enclosing tissue without the 3 layers of vessel wall.\par
A peseudoaneurysm is as a matter of fact a hematoma outside the vessel wall. It must continue to interchange with the vessel lumen to be considered a pseudoaneurysm.\par
Generally is the pseudoaneurysm consequence of an arterial injury, for instance arterial catheterization or penetration trauma.\par
Femoral pseudoaneurysm (0.26\%) is the second most common complication of vascular interventional procedures after bleeding. The incidence is detected as a major vascular complication rate, within 0.02\% and 2\%, accord-ing to different literature reports. Pseudoaneurysm formation is less associated with diagnostic procedures compared to interventional procedures. Color Duplex ultrasonography examination can be a sufficient and effective tool to confirm the diagnosis of pseudoaneurysm and may be a part of treatment with compression technique. (Demirbas) 
\section[{b) Popliteal artery aneurysm}]{b) Popliteal artery aneurysm}\par
Aneurysms form for a variety of different internal and external factors like atherosclerosis, infection, etc. Popliteal artery aneurysms are rarely symptomatic and usually discovered on routine physical examination. They tend to occur in elderly and form the most common true peripheral aneurysm, more frequently than femoral artery aneurysms, but less frequently than abdominal aortic aneurysm. The prevalence of popliteal aneurysm in the general population is difficult to determine, but appears to be increasing possibly due to more common use of imaging modalities and an aging population  {\ref (Björck \& Ravn)}.\par
A screening study of 1074 men identified popliteal artery aneurysm in 1 percent  {\ref (Trickett)}. In another screening study of men between the ages of 65 and 74, abdominal aortic aneurysms were identified in 4.9 percent of patients (Diwan, Sarkar, \& Stanley). Of these patients, 6.8 percent had femoral artery aneurysms and 9.6 percent had popliteal artery aneurysms.\par
US are often the initial imaging modality of choice, however CT is useful for assessment of vessels distal to the aneurysm. 
\section[{c) Arterio Venous Fistula}]{c) Arterio Venous Fistula}\par
An arterio venous fistula is an abnormal connection between an artery and a vein, bypassing some capillaries. When this happens tissues below the bypassed cappilaries receive less blood supply.\par
An AVF could raise secondary to trauma, postinterventional or congenital (for example Rendu-Osler-Weber-syndrome).\par
These lesions are extremely difficult to diagnose or treat because of varying of clinical manifestation and very high recurrence rate. The main locations are headneck (40\% of cases) and extremities (40\% of cases).\par
The malformation caused by abnormal differentiation during embryogenesis, may not be evident until additional growth or vascular engorgement as a response to thrombosis, trauma or infection.\par
The vascular malformation could consist one or several feeding arteries and drainage veins plus nidus. Depend of type of malformation the therapy consist of sclerotherapy with or without flow control procedure by using balloon catheter or coils to occlude the drainage vein.  40\% mortality. Penetrating and blunt injuries to the popliteal artery have mortalities of 10.5 and 27.5\%, respectively, and injuries to the tibial arteries have an amputation rate of 38\%  {\ref (Chatt)}.\par
Both multislice computerized angiotomography and magnetic resonance angiography are being increasingly used for the diagnosis and surgical planning. Magnetic resonance angiography enables 3dimensional images to be obtained safely of the whole abdomen, the pelvis, and the lower limbs at one single study. 
\section[{VI.}]{VI.} 
\section[{Occlusive Arterial Disease a) Definitions and classification systems}]{Occlusive Arterial Disease a) Definitions and classification systems}\par
Intermittent claudication is a clinical diagnosis given for muscle pain caused by too little blood flow during exercise.\par
Symptoms of PAD as known are pain or color changes in the extremities, due to metabolic abnormalities because of reduced blood flow and O2 delivery.\par
The term peripheral arterial disease (PAD), also known as peripheral artery occlusive disease or peripheral vascular disease implies to the hemodynamic stenosis or obstruction of arteries. In the context of this paper peripheral arterial disease (PAD) refers to the diseases of the infrainguinal arteries, includes a subset of femoropopliteal and infrapopliteal segment.\par
Vascular disease of the upper extremity and coronary arteries have not been implied primarily Vessels continuity is maintained and blood flow is preserved apparently from proximal to distal. That`s why disease of the proximal arteries always have a crucial impact on all downstream arteries, so-called run-in effect. Conversely, run-off effect refers to affection of the proximal vessels (upstream circulation) by disease of the downstream vessels.\par
Consequently, due to the pathophysiological point of view, there is a composed interconnected vessel network distal to the abdominal aorta that construct a hydrodynamic functional unit.\par
However, for the purposes of endovascular therapy, separation of the peripheral vascular bed into vascular segments and territories is useful, mainly because of differences in vessel structure and morphology that prescribe different interventional strategies. (Lanzer) 
\section[{b) Classification of PAD based on symptom severity}]{b) Classification of PAD based on symptom severity}\par
Intermittent claudication is a symptom produced consistently by physical exercise such as walking and is relieved by a period of rest. The severity of the symptoms can be determined in the clinical setting utilizing different classifications.\par
Standard classifications such as the Fontaine or Rutherford scales are commonly used in research settings and do not correlate well with the degree of disability experienced by patients.\par
The classification by Fontaine has two stages of claudication whereas the Rutherford classification is more differentiated.\par
Both categorise PAD in terms of symptoms (asymptomatic, intermittent claudication, ischemic rest pain or ulceration and/or gangrene) and severity (mild, moderate or severe).\par
The Fontaine classification classifies according to the spectrum and severity of the presented symptoms, the distance that a patient can walk before pain occurs (pain free walking distance) dividing into two groups based upon a PFWD of greater than or less than 200 metres. The Rutherford classification uses three groups based upon a combination of the results of a treadmill exercise test and ABI values.  {\ref (} As coronary artery disease, the most common cause of symptomatic obstruction in the peripheral arterial tree is atherosclerosis, a primarily systemic inflammatory process. The response to arterial wall injury induces an inflammatory reaction, which over time forms the histopathological basis of PAD, identical to that seen in the coronary vasculature and brain vascular bed by development of atherosclerosis and subsequent plaque instability.\par
The histopathological basis of disease is identical to that seen in the coronary vasculature and other vascular beds.\par
Proper limit of alcohol intake and regular physical training have both determined as protective. Vasculitides may induce PAD in a small group of patients, because they are not known to affect the peripheral vasculature.\par
The other rare though possible causes of PAD are thromboangiitis obliterans (Burger`s disease), Hypercoagulable states such as protein C or S deficiency or antithrombin III deficiency, and the vasospastic syndromes.\par
Major modifiable risk factors for PAD include diabetes and cigarette smoking. Critical prognosis of PAD, primarily as a harbinger of CVD morbidity and mortality has been well documented and widely recognized. Table \hyperref[tab_1]{2}  The natural history of PAD is slow progression of symptoms over time, at the same time characterized by an increased risk of coronary and cardiovascular ischemic events.\par
There is considerable variation within this overall pattern. In most patients, the disease progression is relatively benign. A great majority of patients will remain asymptomatic or with fairly stable symptoms; some may even show improvement. A large population study found that 5 years after diagnosis of PAD, 63\% of patients showed angiographic progression, but 66\% still had no limiting intermittent claudication. (Garcia) How about asymptomatic PAD? Is it really matter? Coexistence of peripheral arterial disease and coronary artery disease is common. PAD worsens the prognosis of patient with CAD. Dus patients with PAD should be treated for secondary prevention, regardless of diagnosis of CAD.\par
Comparison of patients with PAD versus agematched controls shows an incidence of cardiovascular death of 0.5\% in controls and 2.5\% in the patients with PAD. Additionally, in persons with known coronary artery disease, the presence of PAD raises the risk of death by 25\% in comparison with controls. It is thus important to examine for PAD, even in asymptomatic patients, in order to control the risk factors as soon as possible and reduce mortality4. Clinical experiments have shown that up to 50\% of patients with PAD also have symptoms of cerebrovascular or heart disease.\par
In the PARTNERS study, of all the patients who were screened for vascular disease, only 13\% had isolated PAD with no other manifestation of cardiovascular disease. Thirty-two percent of the patients also had either coronary disease or cerebrovascular disease, and 24\% had involvement in all 3 territories. The main cause of late death in patients with PAD is ischemic heart disease (up to 50\% of deaths VIII. 
\section[{Diagnostic Approach a) Non-Invasive functional assessment}]{Diagnostic Approach a) Non-Invasive functional assessment}\par
Without question, the ankle-brachial index (ABI) result can help diagnose peripheral arterial disease. ABI is easy to perform and most common vascular test to detect impaired vascular insufficiency of the lower extremities.\par
In its most simple form, the test compares blood pressure in the ankle to blood pressure in the arm. A Doppler ultrasound device and standard blood pressure cuff are used to register systolic pressures of both brachial arteries in the supine position at rest. Next, blood pressures are again obtained with the pressure cuff at the ankle, and the Doppler transducer is used to determine systolic pressures of the dorsalis pedis and posterior tibial arteries. As the blood pressure cuff deflates, the blood pressure in the arteries is recorded. A computer converts sound waves into a picture of blood flow in the arteries and veins.\par
The ratio of ankle pressure to brachial pressure (ABI) is then derived. A ratio of ?0.9 is found in patients without claudication. The patient is diagnosed with PAD when the ABI is ? 0.90 and at least 0.5. Patients with rest pain usually have ABIs less than 0.5 and an absolute pressure less than 50 mmHg.  {\ref (Heuser)} In asymptomatic persons, an ABI <0.9 has a sensitivity >95\% and a specificity approaching 100\% as compared with arteriography4.  {\ref (Serrano \& Conejero)} Duplex ultrasonography has a sensitivity of 80\% and a specificity of 90-100\% for detecting femoral and popliteal disease.\par
ABI and Doppler is non-invasive and accurate diagnostic tool to detect and evaluate the arterial flow dynamics in the affected area. But is that enough?\par
Non-invasive functional assessment says there is something wrong but no comprehensive qualitively significant and anatomical information. Without utilizing supplemented radiological depiction there is no ability to plan an intervention.\par
Spiral computed tomography and Magnetic resonance angiography are new, minimally invasive techniques for vascular imaging. CTA and MRA replaced already the invasive angiography. Multislice computerized tomography can also provide excellent 3dimensional images and give information about the characteristics of the plaque, and all during a very quick 
\section[{Global Journal of Medical Research}]{Global Journal of Medical Research}\par
Volume XV Issue 1 Version I Year 2015 study. A helical scan can cover the entire region of interest in one 10-40 second exposure.\par
Magnetic resonance angiography has the advantage of imaging a moving column of blood and does not require ionising radiation or iodinated contrast, but the technique has obvious drawbacks in terms of cost efficiency and accessibility to scanners. DSA is reserved for interventional procedures. 
\section[{b) PAD Therapy}]{b) PAD Therapy}\par
Lower extremity and specially femoropopliteal segment are the most common anatomic locations of atherosclerotic lesions.\par
Analysis of the distribution of peripheral arterial obstructive disease shows that more than 50\% of all lesions are localized in the femoropopliteal region. Corresponding to the length of this vessel, diffusely stenosed segments and long occlusions dominate over focal stenoses. The natural history of isolated SFA disease predicts a low amputation risk (0-1\%) without surgical revascularization. This benign natural history often drives physicians to avoid surgical or interventional treatment. Endovascular treatment with balloon angioplasty is well accepted for short segmental disease of the femoropopliteal artery. The immediate technical success of revascularization of the femoropopliteal segment by balloon angioplasty is reportedby almost all working groups to be very high, reaching from 80\% to more than 95\%. However, longterm results vary widely from 5-year patency rates of 68\% in patients with stenosis and claudication to only 12\% in patients with occlusion and critical ischemia. (Heuser) Treatment of patients affected by PAD consists of a non-pharmacological (life modification or life style changes) and pharmacological approach. Of course, modification of risk factors is the first measure to implement.\par
For pharmacological treatment of PAD, do not forget, you are treating a systematic disease, therefore such patients need to be identified and treated even more aggressively than patients with CAD only.\par
Treatment strategies of patients with peripheral artery disease have 2 major goals. One, to manage symptoms, optimizes the functional situation of the leg (symptom relief), and 2, to prevent events secondary to the multifocal distribution of the disease.\par
The drugs used in PAD can be directed at specific treatment of the claudication, in an attempt to resume physical activities, or at the secondary prevention of cardiovascular and neurovascular events, thus achieving a better vital prognosis for these patients. 
\section[{( D )}]{( D )} 
\section[{Peripheral Emergencies}]{Peripheral Emergencies}\par
Although diagnostic and therapeutic decisions in patients with vascular disease are guided primarily by the history and physical examination, the use of noninvasive investigations has increased significantly in recent years, mainly as a result of technological advances in ultrasonography. IX. 
\section[{Endovascular Techniques a) Principles of Intervention}]{Endovascular Techniques a) Principles of Intervention}\par
The very most important duty of an interventional radiologist is making a proper imaging to make a treatment plan. Do not forget interventional radiologist is a part of specialized team with surgeons, angiologist and internists. Communication inside the highly specialized vascular team is necessary to make a therapy plan with low risk for the patient.\par
Exact knowledge of peripheral vascular anatomy is required for optimum image acquisition and interpretation.\par
The development of duplex mapping, computer tomography (CTA), and magnetic resonance arteriography (MRA) is likely to obviate the need for much, of the strategic arteriography performed. DSA is reserved for interventional procedures.\par
Technological advances of non-invasive multidetector computer tomographic angiography (CTA) and magnetic resonance angiography (MRA) with threedimensional imaging and their increasing ability to localize and to determine anomalies have transformed the indication and utilization for diagnostic digital subtraction angiography (DSA).\par
Both magnetic resonance angiography (MRA) and computed tomography scan (CTA) are used to detect, evaluate and follow up peripheral vascular lesions.\par
Utilizing invasive digital substraction angiography (DSA) have now become reserved to specific settings, frequently exclusively in combination with interventional procedure standby or depending on actual validity of non-invasive studies in individual patients.\par
To allow definitive decisions on the need for and technical feasibility of peripheral arterial revascularization, diagnostic arteriography should provide a full anatomic and morphologic definition of arteries and lesions from the infrarenal abdominal aorta down to the arteries of the feet. In cases with suboptimal MR or CT image quality or incomplete vascular definition, diagnostic angiography is prescribed to complete the study and to allow definitive statements. In patients with complex multilevel PAD, diagnostic angiography with intervention stand by might be preferable, allowing a single-stage definitive assessment and treatment decisions.  {\ref (Schneider)} In the world of modern angiography, many different purposes can be accomplished, the most important ones are: strategic planning and guiding endovascular interventions. Arteriography presently provides much of the information used for the strategic planning of vascular reconstruction. It is still the most common strategic method with which most vascular specialists are familiar and comfortable. Once endovascular therapy has been selected as the treatment approach of choice, arteriography is the best way to guide the intervention. Intermittent periprocedural arteriography is crucial to guide wire and device passage and assessment of the results of treatment. (Schneider) 
\section[{b) Angioplasty/stenting}]{b) Angioplasty/stenting}\par
The number of percutaneous transluminal angioplasties performed for claudication has risen steeply in recent years. Percutaneous transluminal angioplasty seems best suited for stenoses or short occlusions of the iliac and superficial femoral vessels, with one-year patency rates of 90\% and 80\% respectively.\par
Angioplasty provides the best results in short lesions, preferably stenosis and non-calcified lesions in D D D D the common iliac artery. Its long-term results in these situations are good, with permeability figures of 70\% at 5 years for patients with claudication41. However, when it is performed in longer lesions, especially when complete occlusions are recanalized, the permeability is clearly lower. The advantages of implanting a stent in iliac angioplasties have been assessed in clinical trials, with permeability figures just a little better for systematic stenting as compared with simple balloon angioplasty42-44. The best approach is probably to implant a stent selectively in those patients in whom balloon angioplasty shows an initially suboptimal result.\par
In general, we can say that short lesions, less than 10 cm, preferably with stenosis, are the most suitable for endovascular treatment45-48, especially angioplasty, whereas stents have shown a high rate of fractures with important clinical consequences. In longer lesions, the use of expanded polytetrafluoroethylene coated stents seems to afford advantages over the other methods, though randomized studies with a greater follow-up are required49.  {\ref (Serrano \& Conejero)} Evidence suggests that balloon angioplasty is the procedure of choice for iliac and femoropoliteal   
\section[{c) Indications for Surgery}]{c) Indications for Surgery}\par
The indication for surgical treatment (conventional or endovascular) of PAD depends above all on the joint evaluation of 2 fundamental aspects, the clinical situation of the patient and the vascular bed that requires reconstruction (Table \hyperref[tab_3]{4}).\par
The clearest indication for revascularization is the patient with advanced stages of ischemia (III and IV), due to the high risk of loss of limb resulting from these situations.  {\ref (Serrano \& Conejero)} The development of new endovascular techniques has resulted in debate about their role in occlusive arterial disease. An expert group has drawn up a document dealing with the recommendations for treatment, known as the TASC (Inter-Society Consensus for the Management of Peripheral Arterial Disease), whose first edition was published in 2000 and with a second revision announced in 2007. This document includes multiple recommendations about the treatment of patients with PAD and establishes 4 categories (A, B, C, and D), according to the morphology and extension of the disease.  {\ref (Serrano \& Conejero)}  
\section[{d) Differential diagnosis of leg pain}]{d) Differential diagnosis of leg pain}\par
Most leg pain results from different conditions, from wear and tear, overuse, or injuries in joints or bones or in muscles, ligaments, tendons or other soft tissues. Some types of leg pain can be traced to problems in lower spine. Blood clots, varicose veins or poor circulation can also cause leg pain.\par
In all cases of suggested PAD, nonvascular causes of symptoms (pseudo claudication) such as nerve root compression, spinal stenosis, hip arthritis, and others must be considered and excluded.\begin{figure}[htbp]
\noindent\textbf{1}\includegraphics[]{image-2.png}
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\noindent\textbf{4}\includegraphics[]{image-5.png}
\caption{\label{fig_4}Figure 4 :}\end{figure}
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\noindent\textbf{}\includegraphics[]{image-6.png}
\caption{\label{fig_5}}\end{figure}
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\noindent\textbf{5}\includegraphics[]{image-7.png}
\caption{\label{fig_6}Figure 5 :}\end{figure}
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\noindent\textbf{1}\includegraphics[]{image-8.png}
\caption{\label{fig_7}Volume XV Issue 1}\end{figure}
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\noindent\textbf{}\includegraphics[]{image-9.png}
\caption{\label{fig_8}}\end{figure}
   \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.85\textwidth}}
Layden,\end{longtable} \par
 
\caption{\label{tab_0}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.14825581395348839\textwidth}P{0.2668604651162791\textwidth}P{0.23720930232558138\textwidth}P{0.19767441860465115\textwidth}}
\tabcellsep Annual Incidence\tabcellsep prevalence\tabcellsep Mortality\\
Stroke\tabcellsep 0.73\tabcellsep 4.6\tabcellsep 28\\
TIA\tabcellsep 0.50\tabcellsep 4.9\tabcellsep 6.3\\
ACS\tabcellsep 2.3\tabcellsep 12.6\tabcellsep 45\\
PAD\tabcellsep \tabcellsep 8-12\tabcellsep 4-25\end{longtable} \par
  {\small\itshape [Note: the annual incidence, prevalence and mortalityof patients with PAD, ACS, TIA and stroke Criqui M,et al. Circulation 1985; 71:510]} 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.38026315789473686\textwidth}P{0.19236842105263158\textwidth}P{0.1386842105263158\textwidth}P{0.1386842105263158\textwidth}}
\tabcellsep Reduction of\tabcellsep Relative risk reduction\tabcellsep Number needed to treat\\
\tabcellsep events/year\tabcellsep \tabcellsep \\
Aspirin vs. placebo\tabcellsep 4.6\%\tabcellsep 15\tabcellsep 140\\
Clopidogrel vs. aspirin\tabcellsep 4.8\%\tabcellsep 24\tabcellsep 94\\
Ramipril vs. placebo\tabcellsep 4.4\%\tabcellsep 26\tabcellsep 88\\
Simvastatin vs. placebo\tabcellsep 6.1\%\tabcellsep 21\tabcellsep 86\end{longtable} \par
 
\caption{\label{tab_2}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.09193262411347518\textwidth}P{0.4702127659574468\textwidth}P{0.287854609929078\textwidth}}
Type A\tabcellsep ?\tabcellsep Single Stenosis ? 10 cm\\
Lesions\tabcellsep ?\tabcellsep Single Oclusion ? 5 cm\\
Type B\tabcellsep ?\tabcellsep Multiple Lesions each ? 5 cm\\
Lesions\tabcellsep ?\tabcellsep Single Stenosis or Oclusions ? 15\\
\tabcellsep \multicolumn{2}{l}{cm (not Involving the Infrageniculate Popliteal}\\
\tabcellsep Artery)\tabcellsep \\
Year 2015\tabcellsep \multicolumn{2}{l}{? Absence of continuous Tibial Vessels to Single or Multiple Lesions in the Improve Inflow for a Distal Bypass ? Heavily Calcified Oclusion ? 5 cm}\\
\tabcellsep ?\tabcellsep Single Popliteal Stenosis\\
Type C\tabcellsep ?\tabcellsep Multiple Stenosis or Oclusion\\
Lesions\tabcellsep \multicolumn{2}{l}{Totaling > 15 cm With or Without Heavy}\\
\tabcellsep \multicolumn{2}{l}{Calcification}\\
\tabcellsep ?\tabcellsep Recurrent Stenoses or Oclusions\\
\tabcellsep \multicolumn{2}{l}{That Need Treatment After 2 Endovascular}\\
\tabcellsep \multicolumn{2}{l}{Interventions}\\
Type D\tabcellsep ?\tabcellsep \\
Lesions\tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_3}Table 4 :}\end{figure}
 			\footnote{© 2015 Global Journals Inc. (US)} 			\footnote{Volume XV Issue 1 Version I © 2015 Global Journals Inc. (US)} 		 		\backmatter  			  				\begin{bibitemlist}{1}
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\end{document}
