“POBA Plus”

Abstract

Endovascular therapy of arterial occlusive disease has made impressive progress since the first balloon angioplasty conceived by Dr Charles T. Dotter in 1964, followed by the first peripheral balloon angioplasty by Dr Andreas Gruntzig in 1974. Each advancement has frequently faced skepticism after the initial clinical experience. Thankfully, skepticism was met in kind with research seeking facile, minimally invasive, durable, safe, and cost-effective arterial occlusive disease therapy. The result is an impressive and successful multidecade international investment in coronary artery disease (CAD) therapy. Improvements from “plain old balloon angioplasty” (“POBA”) to endovascular stenting and drug-eluting stents have shown impressive clinical and quality-of-life gains for patients with CAD. Based on large, randomized clinical trials in CAD, these technologies have resulted in universal reimbursement and wide penetration in clinical practice worldwide. Patients with acute myocardial infarction treated by endovascular techniques have fewer clinical events and improved survival. Individuals with CAD and angina, especially those with symptoms refractory to medical therapy, enjoy improved quality of life. Article p 1358 More than 9 million people in the United States and as many as 27 million in North America and Europe have atherosclerotic peripheral artery disease (PAD). Of these, ≈10% have classic claudication, another 40% experience atypical leg symptoms, and a smaller cohort suffer critical limb ischemia.1 Recent data have demonstrated that care offered for such individuals is now associated with large healthcare costs ($4.37 billion in 2001 among Medicare beneficiaries).2 These costs are comparable to or greater than those for other common cardiovascular diseases (eg, cardiac dysrhythmias, congestive heart failure, and cerebrovascular disease). In distinct contrast to the health gains for individuals with CAD, comparable advances have not been achieved for patients with PAD. Despite comparable PAD prevalence in 2008, patients with PAD continue to have higher mortality and worse quality of …