eMedicine Specialties > Radiology > Vascular/Interventional

Lower-Extremity Atherosclerotic Arterial Disease: Follow-up

Author: Chadi Chahin, MD, Staff Physician, Department of Radiology, Aultman Health Foundation/Mercy Medical Center
Coauthor(s): Barry Rose, MD, Associate Professor of Radiology, Northeastern Ohio Universities College of Medicine; Program Director, Department of Radiology, Aultman Hospital; Sam Stuhlmiller, MD, Consulting Staff, Department of Radiology, Aultman Hospital
Contributor Information and Disclosures

Updated: Feb 9, 2007

Intervention

The past decade has brought expanded use of endovascular therapies in the treatment of patients with lower-extremity occlusive vascular disease, with surgical revascularization procedures playing an ever-diminishing role. Several factors have contributed to this trend: patient risk factors for surgery, hospitalization time, recurrence rates, and comparison of minimally invasive approaches to highly invasive surgery. Interventional methods are divided into balloon angioplasty with intravascular stenting and those without stenting.

In the early days, the principle mode of action with balloon angioplasty was believed to be compression of the plaque. Currently, balloon angioplasty is known to be effective by creating a controlled plaque fracture with associated stretching of the media and adventitia of the artery, thereby enlarging the lumen. The increased use of balloon angioplasty has been accompanied by an increase in the awareness of recurrent postangioplasty stenosis, which created the need for early or late stenting. Recurrent stenosis is usually caused by recoil of the arterial wall and plaque or by the progression of atherosclerosis in the area.

The two most common types of stents include the following:

  • Type 1 - Self-expandable stents (eg, Wallstent)
  • Type 2 - Balloon expandable stents (eg, Palmaz stent) deployed by an angioplasty balloon

All of the published data show that best results are obtained when the disease in common iliac artery, although the outcome is also good when the disease is located in the superficial femoral or popliteal artery.

The field of endovascular surgery is growing rapidly, as are improvement in available instruments and expertise. Currently, atherosclerotic iliac artery stenosis responds well to simple balloon angioplasty, and it has the best results of all of the peripheral vessels. Although many complications and technical failures are still encountered, the excellent results of endoluminal treatment in patients with iliac artery occlusive disease and the relatively low risk for complications (compared with surgical revascularization) ensure an enduring role for this modality. The application of this study in other portions of the vascular tree is still being investigated, but results are promising.

 


More on Lower-Extremity Atherosclerotic Arterial Disease

Overview: Lower-Extremity Atherosclerotic Arterial Disease
Imaging: Lower-Extremity Atherosclerotic Arterial Disease
Follow-up: Lower-Extremity Atherosclerotic Arterial Disease
Multimedia: Lower-Extremity Atherosclerotic Arterial Disease
References
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References

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Further Reading

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Keywords

arteriosclerosis obliterans, lower extremity peripheral vascular disease, lower extremity peripheral arterial disease, atherosclerosis, lower-extremity peripheral arterial disease, LEPAD

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Contributor Information and Disclosures

Author

Chadi Chahin, MD, Staff Physician, Department of Radiology, Aultman Health Foundation/Mercy Medical Center
Chadi Chahin, MD is a member of the following medical societies: American College of Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Barry Rose, MD, Associate Professor of Radiology, Northeastern Ohio Universities College of Medicine; Program Director, Department of Radiology, Aultman Hospital
Barry Rose, MD is a member of the following medical societies: American College of Radiology, American Medical Association, Association of University Radiologists, Ohio State Medical Association, and Radiological Society of North America
Disclosure: Nothing to disclose.

Sam Stuhlmiller, MD, Consulting Staff, Department of Radiology, Aultman Hospital
Sam Stuhlmiller, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Anthony Watkinson, MD, Professor of Interventional Radiology, The Peninsula Medical School; Consultant and Senior Lecturer, Department of Radiology, The Royal Devon and Exeter Hospital, UK
Anthony Watkinson, MD is a member of the following medical societies: Radiological Society of North America, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

George Hartnell, MB, Professor of Radiology, Tufts University School of Medicine, Director of Cardiovascular and Interventional Radiology, Department of Radiology, Baystate Medical Center
George Hartnell, MB is a member of the following medical societies: American College of Cardiology, American College of Radiology, American Heart Association, Association of University Radiologists, British Institute of Radiology, British Medical Association, Massachusetts Medical Society, Radiological Society of North America, Royal College of Physicians, Royal College of Radiologists, and Society of Cardiovascular and Interventional Radiology
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Kyung J Cho, MD, FACR, William Martel Professor of Radiology, Fellowship Program Director, Department of Radiology, Division of Interventional Radiology, University of Michigan Medical School
Kyung J Cho, MD, FACR is a member of the following medical societies: American College of Radiology, American Heart Association, American Medical Association, American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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