[Endovascular procedures for peripheral arterial disease]

Since the introduction of percutaneous transluminal angioplasty (PTA) for peripheral arterial disease in the mid-1970s, PTA on occlusive ilio-femoral arterial lesions has become a widely accepted technique. As endovascular techniques have the advantage of lower morbidity and mortality risk compared with open surgical revascularizations. PTA has been applied for the treatment of focal disease. During the past 10 years, stents have played an important role in ameliorating long-term PTA results preventing recoil and PTA-related flow-limiting dissection. Moreover, intravascular ultrasound scanning provides an accurate measurement of the diameter of the diseased arteries and can be used to evaluate plaque morphology and provide structural information assessing the adequacy of stent deployment. Thus PTA procedures with primary stenting extend the indication for more diffuse, multilevel, complex, or totally occluded atherosclerotic segments. Combined surgical and endovascular procedures are increasingly being employed for the common occurrence of multilevel disease in patients with critical limb ischemia. Intimal hyperplasia is thought to be the most important cause of in-stent restenosis following stent deployment. An increase in cell number in the inner intima and accumulation of matrix around stents have been observed in resected arterial specimens with in-stent lesions, which could be prevented by radiation therapy or sirolimus-eluting stents in the very near future.