1) To learn the indications for endovascular treatment of PAD. 2) To learn the standard technique of PTA and stenting. 3) To learn the medical treatment before and after endovascular therapy. 4) To learn the results of endovascular treatment of PTA, stents and stentgrafts.
Revascularisation of the iliac arteries and the superficial femoral artery (SFA) is the most commonly performed endovascular procedure. Clinical indications are patients with intermittent claudication after risk factor modification and exercise training without significant improvement of the walking distance and patients with critical limb ischemia. Anatomic indications were defined by the TASC II working group.
The technical and clinical success rate of percutaneous transluminal angioplasty (PTA) of iliac and femoropopliteal artery stenoses in all reports exceeds 95%. Device developments such as hydrophilic guide wires and technical developments, such as subintimal recanalization, provide high recanalization rates in total occlusions of more than 85%. The mid- and long-term results of PTA versus stenting of the iliac arteries and SFA were reported repeatedly. Risk factors for recurrence were analyzed by multivariate stepwise backward regression analyses in various studies. Clinical stage of disease (intermittent claudication versus critical limb ischemia), length of lesion and outflow disease were most commonly found as independent risk factors for restenoses.
The Dutch iliac stent trial evaluated a primary stent versus secondary stent strategy in iliac artery disease. Patency rates did not show a significant difference. Recently three randomized trials comparing PTA versus stenting with nitinol stents of TASC A and B lesions of the femoropopliteal artery in patients with PAD were published. Two of the trials showed a significant longer 1 year patency rate after primary stenting of SFA lesions. Another randomized trial comparing Viabahn stentgrafts and PTA revealed a significant longer patency rate for the Viabahn as well. Revascularization of infrapopliteal arteries is gaining attention increasingly. The use of stents and drug eluting stents has shown promising results.
Lammer, J,
Procedures for Peripheral Vascular Disease. Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL.
http://archive.rsna.org/2009/8001316.html
