ABSTRACT
Balloon angioplasty and stents expand the scope of patients who are eligible for treatment of infrainguinal occlusive disease. Several newer techniques are developing that substantially increase the spectrum of treatment options and these are detailed in chapter 25. Endovascular infrainguinal techniques are most useful in patients who are poor candidates for open surgery and in those with focal, short segment disease. The long-term results of femoropopliteal angioplasty are not generally as good as those for surgery and vary significantly based upon the severity and extent of the occlusive disease. The current practice of infrainguinal intervention may differ substantially from institution to institution based upon the level of enthusiasm for these techniques. 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. Chapter 3 shows how to perform an antegrade puncture. Chapter 9 provides methods for antegrade passage into the ipsilateral superficial femoral artery (SFA) and also crossing the aortic bifurcation. Chapter 10 details techniques for including the lower extremity in an arteriographic runoff study and for performing femoral arteriography and selective lower-extremity and pedal arteriography.
