Transcatheter Interventions for the Treatment of Peripheral Atherosclerotic Lesions: Part I
Section snippets
INTRODUCTION
SVEN Ivar Seldinger's elegantly simple technique for introducing catheters into arteries began a revolution in the diagnosis and treatment of cardiovascular disease (1) The subsequent contributions of Charles Dotter (2), Kurt Amplatz (3), Andreas Gruntzig (4), Julio Palmaz (5) and others accelerated the development of image-guided endovascular interventions and changed forever the course of cardiovascular medicine. These were the first of the “minimally invasive therapies,” a term now applied
MATERIALS AND METHODS
In this review of transcatheter endovascular procedures, we have attempted to include reports that provide high quality of evidence (QOE) for decision-making concerning therapy. The quality of evidence is based on safety, efficacy, and, where available, cost-effectiveness. Unfortunately, existing QOE is not uniform across all procedures. There are few properly randomized controlled trials (RCTs; US Preventive Services Task Force QOE Level I, see Appendix); for many of the procedures discussed
Balloon PTA and Stent Placement
Several percutaneous revascularization techniques exist for the treatment of PAD of the lower extremities. Because the associated risks of periprocedural mortality and morbidity are low, revascularization for intermittent claudication, even at an early stage, is a viable alternative. However, percutaneous techniques generally yield lower patency rates than surgery, and both percutaneous and surgical procedures are expensive. Therefore, an understanding of the tradeoffs helps to determine
DISCUSSION
Considerable progress has been made in generating supporting evidence for the appropriate application of transcatheter treatment for peripheral atherosclerosis, but there are significant gaps in our knowledge. For treatment such as lower extremity PTA and thrombolytic therapy, a higher quality of evidence (Level I) exists, and early medical decision models and cost-effectiveness data are emerging. There is good evidence to recommend these therapies for the specific indications discussed herein.
Acknowledgments
Editors: Drs. Kandarpa and Becker. Section authors and guarantors of data integrity: lower extremity angioplasty and stent placement, Dr. Hunink; Lower extremity thrombolysis, Drs. Kandarpa and Semba; Upper extremity angioplasty and stent placement, Dr. McNamara; Renal artery angioplasty and stent placement, Drs. Rundback, Sos, and Trost; Mesenteric artery interventions, Drs. Rundback and Poplausky. Literature research and manuscript preparation, Ms. Landow.
We thank Cathy Mendelsohn and Chris
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Cited by (0)
This paper was supported in part by a Cardiovascular and Interventional Radiology Research and Education Foundation (CIRREF) grant and an in-kind contribution by the Society of Cardiovascular & Interventional Radiology (SCVIR), Fairfax, Virginia.
Assessment of Radiological Technology and Department of Radiology and Department of Epidemiology & Biostatistics (M.G.M.H.), Erasmus University Medical Center, Rotterdam, The Netherlands.