Intravascular Ultrasound and Peripheral Endovascular Interventions

textabstractIn recent years the interest in minimal invasive surgery has been growing and the same trend can be observed in vascular surgery, leading to what is commonly referred to as lIendovascular surgery". Although the 1990s represent an era of technical revolution in vascular surgery, it is a misunderstanding to consider endovascular treatment a recent development. In 1947 J050 Cid dos Santos described the thrombo-endarterectomy'; this technique was modified by Vollmar in 1964, to a semi-closed endarterectomy using ringstrippers'> In the same year other pioneers, including Dotter and Judkins, published prelinlinary results on what they called "angioplasty" of the femoropopliteal artery using coaxial eatheters.3 This technique was later modified by Griintzig in 1974, who replaced the coaxial catheters with dilatation balloons.' In the early 1990s, Volodos and Parodi introduced the endovascular treatment of the abdominal aortic aneurysm with a device composed of a Dacron graft and Palmaz stents.5 ,6 The collaboration between interventional radiologists and vascular surgeons has been of eminent importance for further evolution of endovascular teclmiques. Nowadays a great variety of obstmctive and aneurysmal peripheral vascular diseases can be treated with catheter-guided, endovascular and, therefore, less invasive techniques. The development of these endovascular techniques prompted the need for improved vascular imaging and better diagnostics. Since angiography displays only a "lumenogram II of the vessel, tills prechldes qualitative evaluation of atherosclerotic plaque and quantitative assessment of plaque and vessel. Sophisticated modalities such as colour duplex, computed tomographic angiography and magnetic resonance imaging can be important in the pre- and postintervention assessment of vascular disease. These techniques, however, do not always give accurate information on the dimensions of the vessel or the extent of the disease and at the present time cannot be used during intervention.7 Intravascular ultrasound depicts both the vascular lumen and vascular wall: thus, information can be obtained on the atheromatous plaque constituents and the size of the lumen, vessel wall and arterial disease