[Endovascular treatment: peripheral vascular disease]

Peripheral arterial disease comprises those entities that result in obstruction to blood flow in the supra-aortic, mesenteric, renal and infrainguinal vessels. This review focuses on the endovascular treatment of extracranial internal carotid obstructive lesions, descending thoracic aorta aneurysms, and reconstruction of the aortoiliac bifurcation. The utilization of carotid artery stenting as a less invasive alternative to the surgical treatment for the extracranial internal carotid artery stenosis has progressively increased. Preliminary reports of carotid stenting with distal protection have shown a favorable reduction in the adverse event rates; but, the advantage of the endovascular approach has to be established in comparative and randomized trials. Transluminal endovascular stent grafting is rapidly emerging as a modality to repair descending thoracic aorta aneurysms. Preliminary experience has demonstrated the feasibility and safety of endovascular stent-graft treatment. However, further long-term follow-up is mandatory. Reconstruction of the aortoiliac bifurcation is not usually considered an indication for percutaneous treatment. Although there is limited experience, the results are encouraging with > 90% technical success and high primary patency at 3 years. Endovascular intervention has the potential benefit to reduce the cardiopulmonary and neurological complications and to be applicable to most traditional vascular operations.