Percutaneous transluminal angioplasty: general principles.

The introduction and availability of balloon catheters has been responsible for the recent popularity of percutaneous transluminal angioplasty (PTA) in the United States. Available balloon catheters are either double-lumen or coaxial systems. Most balloons are made of polyvinyl but one manufacturer has produced an angioplasty catheter made of specially treated polyethylene, which exhibits higher tensile and yield strength in comparison to polyvinyl. Automatic pressure injectors are necessary for the coaxial balloon system. They are not used with single catheters and larger balloons. Devices monitoring balloon inflation pressures are now available and they should be used. There is no consensus on the use of anticoagulant therapy in conjunction with PTA. Complications of PTA are few and easy to manage. Noninvasive hemodynamic studies (Doppler and pulse volume recordings) are necessary during PTA and for evaluation of long-term patency. PTA should be performed by experienced angiographers in hospitals with adequate angiographic and vascular surgical facilities. Decisions about PTA and subsequent patient management are best made in consultation with the patient's primary physician, a vascular radiologist, and a vascular surgeon.