Vascular Disease: Medical Therapy, Surgery and Interventional Technologies

Thirty years since the advent of balloon coronary angioplasty have seen dramatic advances in percutaneous interventional technologies, not just in the coronary vasculature, but also in other arterial territories affected by atherosclerosis. Multiple disciplines have developed expertise in the treatment of these disorders including interventional cardiologists, vascular sur- geons, interventional radiologists, and vascular medicine spe- cialists. An increased diagnostic awareness of the clinical mani- festations of atherosclerotic vascular disease and major advances in the medical management of their common risk factors has had a major affect on the natural history of these disorders. Yet considerable controversy still exists surrounding the exact role and indication for medical vs revascularization therapies and whether percutaneous or surgery revascularization is equiva- lent or even preferable in any given vascular territory. In this issue of Medicine & Health/Rhode Island we attempt to clarify some the controversies surrounding four distinct vascular enti- ties and provide the most current guidelines for the evaluation and management of these patients. "Current Status of Drug-Eluting Coronary Stents" reviews the risks and benefits of drug eluting vs bare metal stents, and the importance of long-term dual anti-platelet therapy in re- ducing the incidence of subacute stent thrombosis. "An Up- date on Carotid Artery Stenosis" focuses on the importance of Duplex carotid ultrasound imaging for the diagnosis and serial follow-up of carotid artery disease, and reviews recent clinical trials comparing medical therapy, carotid endarterectomy and carotid artery stenting. "Contemporary Management of Pe- ripheral Arterial Disease (PAD)" examines the differential di- agnosis of lower extremity discomfort, the importance of the ankle-brachial index as a screening test for PAD and an algo- rithm of different treatment modalities. "The Clincial and Therapeutic Implications of Renal Artery Stenosis" compares the distinctive clinical presentations of Athersclerotic Renal Artery Stenosis and Fibromuscular Dysplasia and reviews the roles of medical therapy, and endovascular and surgical revascularization in the management of these patients.