Advances in balloon technology and reperfusion devices for peripheral circulation.

Major improvements in balloon and wire technology have been occurring for several years and, consequently, the approach to conventional angioplasty has been simplified. Results in isolated stenotic segments in renal circulation and within the iliac and superficial femoral vessels have generally been 95% technically successful, with 1-year patency rates of 80% in the superficial and renal sites and 90% in the iliac vessels. The procedure has been extended to include more distal vessels including the popliteal and tibial circulation as well as more complex lesions involving the mesenteric circulation and pre-Leriche syndromes with stenotic disease involving the infrarenal segment of the abdominal aorta. Successful results have also been achieved in stenotic atherosclerotic disease involving the subclavian artery and the associated subclavian steal syndromes. Preliminary results are also being reported in a few selected series of vertebral and carotid artery angioplasty. Totally occluded segments in the iliac and peripheral circulation had previously been ammenable only to surgical bypass procedures. A series of new recanalization devices are under investigational evaluation for reperfusing these totally obstructed segments. Although technical recanalization in segments as long as 20 cm can be accomplished in approximately 75% of these patients, long-term patency is totally dependent on popliteal-tibial outflow. For these reasons, diffuse disease and totally obstructive disease in the superficial femoral vessels can have recurrence rates as high as 45%, and reestablishing tibial outflow is equally as important as successfully recanalizing the totally obstructed superficial femoral vessels.