Guidelines for Peripheral Percutaneous Transluminal Angioplasty of the Abdominal Aorta and Lower Extremity Vessels

The diagnosis and management of peripheral vascular disease has undergone tremendous change during the past two decades. Diagnostic angiography is complemented and, in some cases, even supplanted by digital subtraction techniques, duplex sonography, intravascular ultrasound, and magnetic resonance imaging. Similarly, percutaneous transluminal angioplasty has evolved from a novelty to a vital component in the treatment of peripheral vascular disease. This document discusses the background and current state of peripheral angioplasty, including the prevalence of peripheral atherosclerosis and the history, clinical results, and risks of angioplasty. As a less invasive treatment, angioplasty has been placed in an awkward position between surgery and nonoperative therapy. To clarify the role of angioplasty, the determinants of success, requisite symptoms for intervention, indications for treatment, and appropriate clinical setting are described. Because the alternative treatment is typically surgery when a patient's condition necessitates intervention, the literature comparing the two treatments is reviewed.