Angioplasty and intravascular stents in peripheral vascular disease

Advances in the technique as well as the technology of percutaneous angioplasty over the past 30 years have allowed the percutaneous treatment of many vascular lesions that previously required operative management. PTA, and more recently intravascular stents, have been shown to be effective, safe, and, in some cases, more cost effective than surgical options. Although patients need to be appropriately selected to optimize the treatment plan in individual cases, it is clear that percutaneous treatment, either alone or in combination with surgical procedures, offers a significant advancement in patient care. The success in treating iliac disease is perhaps the most convincing, but evidence is rapidly building to support infrapopliteal procedures, and, as further advances are made in technology, the role of such procedures in distal vessels may be expanded to include more patients. These procedures need to be prospectively evaluated not only for their efficacy, long-term result, and safety, but also for their cost-effectiveness and cost relative to the proven surgical options.