Endovascular Surgery in Daily Practice: A Re-Appraisal

Abstract

For more than 10 years, endoluminal therapy has been marked by an explosion in the number and variety of devices designed to enhance or supplant its first and still most commonly used technique, balloon angioplasty. Among all these innovative catheter-based technologies, only stents have emerged as a truly effective device capable of achieving results comparable or superior to balloon angioplasty. In combination with thrombolysis and balloon dilation, they form the triadic foundation of endovascular surgery today. The prudent and judicious use of these tools, and a few other “niche” devices, such as atherectomy, in conjunction with classical vascular surgical techniques is the special and unique purview of the vascular surgeon. His development of a therapeutic plan, whose components include patient selection, lesion assessment, device decisions, procedure monitoring, completion evaluation, and follow-up, is incumbent upon an appreciation of the capabilities of each available intraluminal device in the various arterial segments and lesion pathologies.

The strategies that facilitate optimum matching of endoluminal tools and techniques to each patient situation form the basis of this report. They offer today's vascular surgeon a guide to the use of intraluminal therapies in daily practice. On the horizon is the new and exciting technique of endoluminal grafting, which, if it proves efficacious, will bring about profound changes in our specialty.