Due to demographic changes, peripheral arterial occlusive disease (PAD) has become one of the most prevalent diseases in western industrial nations. In recent years the trend towards initial endovascular treatment approaches has further continued. Because of the high primary success and low complication rates, intervention-based revascularization strategies are the method of choice in the majority of cases. The treatment strategy should always be assessed in a multidisciplinary setting and if possible, within a designated vascular center. One of the main limitations of interventions is the occurrence of restenosis, in particular in infrapopliteal arterial lesions. A major progress arose from drug-eluting balloons, which dramatically reduced restenosis rates particular for femoropopliteal lesions. A potential alternative strategy could be the use of a combination therapy, such as plaque removal followed by insertion of drug-eluting balloons; however, economic issues have to be kept in mind for such approaches.