Endovascular surgery: past, present, future

In the 33 years since Dotter described his innovative treatment of an arterial obstruction using transluminal dilatation, endovascular therapy has developed into an important and necessary part of the treatment of occlusive vascular diseases. Today, three major endovascular therapies: balloon dilatation, intraluminal stenting, and athrectomy have earned full FDA approval and have predictable and acceptable short- and long-term outcomes. These procedures may be used as "stand alone" therapies or in conjunction with standard vascular surgical reconstructions to provide the best outcome for each patient. In general, endovascular treatment can be expected to result in lower morbidity and mortality than traditional vascular surgical interventions. However, the long-term outcome of these therapies is often less durable. Both the standard and endovascular therapies will likely be performed into the 21st century; so an appropriate treatment program specific for an individual patient can be developed. This program should balance risks of treatment with anticipated benefits when considering the expected longevity and comorbid conditions of the patient. A new technology with limited FDA approval is the technique of endovascular grafting. This technology and the development of new treatments to minimize or prevent restenosis should revolutionize the practice of vascular surgery in the future.