Vascular surgery between the millenniums

Modern diagnostic modalities as well as ongoing improvement of vascular prosthetic material and surgical techniques have stimulated progress in vascular surgery. New discoveries concerning the mechanism of endothelial function, atherosclerosis, developments in gene therapy and endovascular techniques will expand the future therapeutic spectrum of vascular surgery. Endoluminal implantation of stent grafts for the treatment of aortic aneurysm may be a reasonable alternative to conventional surgery, especially in high-risk patients. Long-term results of this procedure, however, are not yet available. Stenting of internal carotid artery stenosis may be considered as an experimental method of treatment. Its feasibility, efficacy, safety and long-term results must be analyzed before the application of the method may be restricted or recommended. Endoluminal irradiation (brachytherapy) reduces intimal hyperplasia/restenosis and can improve the long-term results of percutaneous transluminal angioplasty. Anti-atherosclerotic and anti-aggregatory therapy (with statins, estrogens, antibiotics, nitric oxide precursor/donors, glycoprotein IIb/IIIa receptor inhibitors) will play an important role in the prevention of ischemic diseases and improve the results of surgical/interventional treatment by reducing intimal hyperplasia and restenosis. Gene therapy opens new vistas in vascular medicine. Angiogenetic factors can be used for the treatment of patients with distal occlusion of the peripheral arteries. Gene transfer may be useful in the conservative treatment of progressive aortic aneurysms. A more unified vision toward vascular medicine might be the key for research and development in the future.