IN PERSPECTIVE - ENDOLUMINAL GRAFTING .2. ENDOLUMINAL GRAFTING IN THETREATMENT OF ILIAC AND SUPERFICIAL FEMORAL-ARTERY DISEASE

Treatment of iliac artery disease with stents has been generally succe ssful; however, disease in the smaller arteries below the inguinal lig ament has been more resistant to percutaneous intervention techniques. Ongoing research is evaluating the potential value of newer, more fle xible stents as well as the use of covered endoluminal grafts to ''rel ine'' diseased arterial segments. It is possible that intimal hyperpla sia may be reduced by covering the stent on one or both sides with a f abric such as polytetrafluoroethylene, yielding improvements in long-t erm patency. A number of device manufacturers have developed investiga tional Device Exemption protocols with the Food and Drug Administratio n to allow randomized comparison of covered grafts and uncovered stent s. The use of endoluminal grafts in the treatment of large aneurysms i nvolving the common and internal iliac arteries and the origin of the external iliac artery is also under investigation; this application ma y prove advantageous, since operative intervention in these locations is often difficult. In addition, the endoluminal graft has been used t o manage traumatic or iatrogenic rupture of an iliac artery, and the u se of systems incorporating nitinol stents for an ''internal'' femorop opliteal bypass procedure is also being studied. Although aneurysmal d isease in the superficial femoral artery is uncommon, the use of endol uminal grafts now makes it possible to treat these lesions percutaneou sly with an intraluminal approach; endoluminal graft exclusion of aneu rysmal disease in the popliteal artery is also promising.