Nonsurgical restoration of pulsatile arterial flow

Percutaneous transluminal angioplasty is an established method of revascularization in a variety of arterial stenotic conditions. When applied to specific morphologic and clinical indications, it can be very effective. It appears to be the procedure of choice for focal stenotic lesions of the iliac and femoropopliteal system. Its role in infrapopliteal atherosclerotic disease is less certain, but more optimistic, with recent reports. New methods for preventing restenosis and abrupt closure are currently being developed, and they appear to be promising as adjunctive therapy with mechanical catheter-directed intervention. The future of these adjunctive agents will likely improve the outcome and reduce the immediate failure rates of angioplasty. Other modalities, including thermal laser angioplasty and atherectomy, also appear to have a promising future. These methods, coupled with better endoluminal guidance, such as ultrasound, will help guide the interventional procedure more precisely and hopefully broaden the application and improve the outcome.