Percutaneous Transluminal Treatment of Arteriosclerotic Obstruction

DRUGS, DIET, regulated exercise, and other essentially supportive measures notwithstanding, there is no direct medical treatment for the primary lesion causing atheromatous obstruction. Despite impressive surgical progress, the practical fact remains that most victims of atherosclerosis are not helped by current surgical technic. Vital statistics give grim evidence of the inadequacy of current treatment: 500,000 coronary deaths occur in the United States each year. Though everyone stopped smoking, exercised regularly, ate wisely, and visited their doctors frequently, 50,000,000 Americans would not be able to forestall a disease already within their arteries. If means for prevention were discovered tomorrow, arteriosclerosis would long continue to outrank all other causes of disability and death. It follows that for professional, public health, and personal reasons, atherosclerosis is our most urgent unsolved medical problem. The purpose of this report is to describe a new approach to the treatment of arterial obstruction. Conceived as a possible means for combating atherostenotic ischemia in various locations, the method has thus far been attempted only in the leg, a region where clinical experimentation is frequently the only alternative to amputation (1, 2). Developmental Background One Man's Complication is Another Man's Therapy: Inadvertent intramural dissection by catheters or catheter guides is a fairly common accompaniment of arterial catheterization, especially retrograde femoral- iliac catheterization, in elderly patients. Experienced operators are usually able to avoid this minor complication by a variety of procedural modifications. While sub atheromatous catheter passage is properly considered a complication (and may prevent completion of the intended study), it serves to warn the operator to change the course of the catheter and thus aids in the prevention of a more serious complication, arterial perforation. A review of more than 1,000 arterial contrast examinations performed at the University of Oregon Medical School revealed over 30 instances of periatheromatous contrast visualization, either by injected medium or the demonstration of an extraluminal catheter pathway (3). As had been anticipated, sub- or periatheromatous catheter passage was ordinarily not associated with serious or permanent ill effects. Figure 1 illustrates the apparent passage of a spring guide and catheter through an occluded right iliac artery following entry into the common femoral which was patent and supplied with blood by numerous collateral channels. Figure 2 illustrates a functioning “false” lumen in an iliac artery visualized a week after its inadvertent creation during retrograde iliac catheterization in another laboratory.