[Progress in endovascular therapy of peripheral arteries]

Percutaneous transluminal angioplasty introduced by Grüntzig nearly 30 years ago, remains one of the most often performed treatment for peripheral artery disease. Aortoiliac stenoses as well as short femoropopliteal occlusions are particularly prone to PTA approach. Because catheter intervention is not only limited to balloon dilatation but offers a wide variety of treatment, endovascular treatment tends to replace the generic term PTA. Recent progress in this field extend far beyond imaging improvement. They comprise new revascularisation techniques and lesions that were formerly considered to be solely treatable by surgery become curable by endovascular approaches. Combined treatment associating thromboaspiration with embolectomy in case of acute or subacute infrainguinal occlusions as well as low dose infiltration thrombolysis with or without additional PTA represent now first choice therapeutic interventions. The manufacturing of stents or stent-grafts represents one of the greatest breakthrough in the field of endovascular interventions. Stents have significantly improved post PTA patency particularly in the suprainguinal location. Furthermore, stent-grafts represent an attractive alternative to bypass surgery in a selected population, to exclude aortic aneurysm, mainly below the renal arteries. The last but not the least of the progress in the management of patients with peripheral artery disease is the multidisciplinary approach of the vascular problems by the specialist involved in cardiovascular diseases.