Introduction

Article Outline

• Copyright

The infrainguinal vascular bed, specifically the superficial femoral artery, was the first vascular territory to be attacked by the interventional radiologist for the treatment of peripheral vascular occlusive disease (PAOD). It was Dotter’s groundbreaking percutaneous transluminal angioplasty in 1964 that transformed the angiographer into the interventionalist. Over the subsequent 30 to 40 years, great advances have been made in the treatment of coronary artery disease, recently underscored with the clinical introduction of drug-eluting stents to prevent restenosis; and in the treatment of carotid artery stenosis with the advent of distal protection devices. Ironically, it has been the vessel that Dotter first treated, the superficial femoral artery that has given interventionalists significant “trouble.” With the exception of short focal lesions, there has been relatively little progress in the successful percutaneous treatment of infrainguinal arterial occlusive disease. However, over the past few years, new tools and techniques have been added to the interventionalists’ armamentarium to help conquer this difficult foe.

This issue of Techniques in Vascular and Interventional Radiology will focus on the practical aspects of these new tools and techniques in your practice. The majority of the issue will focus on mechanical methods to treat lower extremity ischemia. For example, it appears that based on the preliminary data presented in this issue the debate of angioplasty versus. stent of the SFA may soon be supplanted by the debate of which type of stent to place in the SFA (bare versus endografts versus drug-eluting stent). Another article reviews the techniques for in-frapopliteal angioplasty and stresses the importance of patient selection when opting for this strategy over surgery.

The final article of this issue moves from a mechanical approach for the treatment of infrainguinal disease to a molecular approach: therapeutic angiogenesis. This research area has been dominated by vascular biologists and cardiologists. However, our unique skills with image-guided therapy offer potential new routes of delivery that may significantly enhance the therapeutic outcome. It is my personal belief that this will be the next frontier for infrainguinal revascularization and it is imperative that interventional radiologists participate in the development of this technology, just as we did with the prior technologies.

Finally, I would like to express my gratitude to the contributing authors for their excellent work. I would also thank three people that have been instrumental in my growth as an interventional radiologist: Charles Semba, Mahmood Razavi, and Michael Dake. They have instilled in me their passion and knowledge for this revolutionary discipline.