Techniques and technology in endovascular surgery

Today's vascular surgeons are no longer confined to the time-honored progressive triad of exercise, medication, and bypass surgery for the treatment of peripheral vascular disease. Our options have expanded to include primary therapy using thrombolysis, laser angioplasty, atherectomy, balloon dilation, and intravascular stents, most of these tecnological categories featuring several devices from which to select. Coupled with the concomitant development of intraluminal assessment and guidance technologies, namely, intravascular ultrasound (IVUS) and angioscopy, today's vascular specialists can evaluate atherosclerotic disease with greatly enhanced accuracy, deriving far more specific information about an obstruction than was ever required for classical vascular reconstruction. In the end, this new specialty of endovascular surgery will provide results equal to those methods used in the past but with less invasiveness. All these options and a more complex diagnostic database require coordination if these new resources are to be used to their fullest advantage for maximal revascularization. It is now incumbent upon vascular surgeons to appreciate the strategies for selecting endovascular interventions based upon lesion pathology and desired outcome.