ABSTRACT
Balloon angioplasty and stents have significantly expanded the scope of patients who are eligible for treatment of infrainguinal occlusive disease. Endovascular infrainguinal techniques are most efficacious in patients who are poor candidates for open surgery and in those with focal, short segment disease. Infrainguinal arteries may be approached through an ipsilateral antegrade femoral puncture or a contralateral femoral puncture followed by passage of the catheter over the aortic bifurcation. In some patients, ipsilateral iliac artery occlusive disease, which the operator may prefer to treat secondarily, must be treated primarily, because it is causing a significant decrease in maneuverability or increased resistance to sheath placement. Many different types of interventions can be performed using a modified plan and a smaller sheath than was the operator’s original intent. Tibial revascularization is a rapidly growing part of endovascular practice. Many of the principles, techniques, and devices required to make tibial procedures a reality have been adopted from other vascular beds.
