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.