Transcatheter interventions for the treatment of peripheral atherosclerotic lesions: Part I

Transcatheter endovascular procedures are increasingly used to treat sympto matic peripheral atherosclerosis. This two-part review identifies the exist ing evidence supportive of the application of transcatheter treatments for peripheral atherosclerotic lesions. The first part addresses the treatment of obstructive lesions that cause limb claudication and critical ischemia, renovascular hypertension and azotemia, and mesenteric ischemia. Studies we re identified via a search of MEDLINE (January 1993 through April 1999) and reference lists of identified articles. When multicenter prospective rando mized trials or other high-quality studies were unavailable, a preference w as given to studies with at least 50 patients per treated group and a minim um mean follow-up duration of 6 months. Data presented in tables are propor tionally weighted averages from included studies. For each application, the authors assessed the quality of evidence (QOE; efficacy, safety, and, wher e available, cost-effectiveness) and made recommendations with appropriate caveats. There is higher QOE supporting the more established treatments suc h as lower limb percutaneous transluminal angioplasty (PTA) with stent plac ement and thrombolysis. Treatments such as renal artery PTA and stent place ment and mesenteric and brachiocephalic PTA are in wide use, but high QOE s upporting general application is lacking. Blanket recommendations based on established efficacy and cost-effectiveness cannot be made. However, the us e of transcatheter therapies can be supported in specific circumstances bas ed on an expected reduction in procedure-related morbidity and/or mortality rates. It is hoped that the identification of deficiencies in the literatu re will inform and inspire critically needed research in this area.