Update on endovascular treatment of peripheral vascular disease: new tools, techniques, and indications

Abstract

The treatment of peripheral vascular disease is one of the most rapidly expanding fields of medicine today At one time, patients who had peripheral vascular disease had few medical or surgical options. Now, however, options abound. The number of peripheral interventions increased from 90,000 in 1994 to more than 200,000 in 1997 and endovascular techniques may soon replace up to 50% of traditional vascular operations. Cardiologists, interventional radiologists, and vascular surgeons bring various types of expertise to endovascular intervention; nonetheless, they seem to share similar levels of enthusiasm about this treatment option. The many advantages to the patient that such intervention offers over traditional surgery, such as the avoidance of anesthesia and other surgical risks, the rapid recovery time, and the relatively low treatment costs, provide encouragement to these specialists. Endovascular intervention requires dedication on the part of practitioners, because it demands such complete knowledge of vascular disease and of the anatomic changes experienced by the patient. The challenge is intensified by the continual introduction of new products and methods. We hope, herein, to offer pertinent information about recent advances in interventional techniques and devices, and to provide a framework for future education.

Fig. 1 The Wallstent® Endoprosthesis (Boston Scientific Corp.; Natick, Mass)

Fig. 10 The Wallgraft™ Endoprosthesis (Boston Scientific)

Fig. 11 Hemobahn™ Endoprosthesis (W.L. Gore & Associates, Inc.; Flagstaff, Ariz)

Fig. 12 The Jostent® Peripheral Stent Graft (Jomed® USA; Conroe, Tex)

Fig. 2 The S.M.A.R.T.® Stent (Cordis Corp.; Warren, NJ)

Fig. 3 The PercuSurge® Guardwire™ temporary occlusion and aspiration system (PercuSurge, Inc.; Sunnyvale, Calif)

Fig. 4 The AngioGuard™ guidewire filter device (Cordis)

Fig. 5 The MedNova NeuroShield Cerebral Protection System (MedNova USA; Topsfield, Mass)

Fig. 6 The EPI filter wire™ (Embolic Protection Inc.; San Carlos, Calif)

Fig. 7 The Ancure™ Bifurcated Endograft System (Guidant/EVT; Menlo Park, Calif)

Fig. 8 The AneuRx™ device (Medtronic AVE; Santa Rosa, Calif)

Fig. 9 The AngioJet® Rheolytic™ Thrombectomy System (Possis Medical, Inc.; Minneapolis, Minn)