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Angioplasty

“The introduction of angioplasty was the beginning of interventional radiology as we know it”

Angioplasty is the fundamental technique that underpins a lot of what we do in interventional radiology. With regard to the use of balloon angioplasty, when Charles Dotter went from using catheters from their original diagnostic use to demonstrating that they could be tools for therapeutic intervention, this was really the birth of interventional radiology as we now know it. The genesis of angioplasty led to all of the other things that we recognise in modern interventional therapy. As it stands 50 years later, the technique has broad applications in terms of peripheral vascular disease and has fundamentally altered the treatment of aortoiliac disease (with or without stenting) and the interventional treatment of critical limb ischaemia. In the UK, critical limb ischaemia has been flagged up as a very important disease entity and there is currently a major focus on raising awareness of the condition and developing strategies to reduce amputation rates.

A recent calculation has suggested that some 50 million angioplasties in all have been performed since that first angioplasty in 1964, which is a pretty impressive total. So it still has a very important place, but is clearly also supplemented by many additional techniques including stenting and more recently, the use of drug-eluting technology.

When we talk about advanced angioplasty, and that would involve stenting, territories in which it is widely used would include the carotid vessels and increasingly the visceral arteries as well. The use of angioplasty and stenting has then morphed to primary stenting and the use of covered stents with further evolution culminating in the introduction of abdominal and thoracic endovascular aneurysm repair.

What we know about angioplasty:

  • We know that angioplasty is a procedure with a high technical success, high efficacy, and low complications rate.
  • We understand that the use of angioplasty in certain arterial locations is better than in others and we know that restenosis remains a major problem after the technique.
  • We know that angioplasty is a technique that continues to evolve, and we have seen significant technical developments such as the use of drug-eluting balloons and drug-eluting stents.