More than 25 million persons in the United States have at least one manifestation of atherosclerosis. Throughout the last 50 years, coronary arterial atherosclerosis has been the focus of basic and clinical investigation; however, the systemic nature of atherosclerosis must be acknowledged (Faxon et al., 2004). Stroke is the third leading cause of death and the principal cause of long-term disability in the United States. There are upward of 600,000 new or recurrent strokes annually. Black populations have a 40% higher stroke rate than white populations and experience a higher mortality. The clinical manifestations of aortic atherosclerosis include abdominal aortic aneurysm, aortic dissection, penetrating aortic ulcer, intramural hematoma, and peripheral atheroembolization. Thoracic aortic aneurysms also occur in patients with atherosclerotic risk factors, but are less common. The age-adjusted prevalence of peripheral arterial disease (PAD) is approximately 12% and may exceed 20% in persons greater than 70 years of age. An ankle–brachial index of less than or equal to 0.90 is 90% sensitive and 95% specific for PAD, identifying a patient population at risk for claudication, rest pain, skin ulceration, and critical leg ischemia, prompting amputation. A majority of patients with PAD have concomitant coronary artery disease (85%) and many have carotid artery disease (60%). Although the true prevalence of renal artery disease proceeding to clinical manifestations such as hypertension or renal insufficiency is unknown, autopsy series of patients with cerebrovascular disease and stroke have identified a high incidence of concomitant disease involving at least one renal artery. Vascular disease of the peripheral arterial circulation, most often caused by atherosclerosis and less commonly by vasculitis (or other nonatherosclerotic arteriopathies), is a chronic process that is responsible for progressive and, at times, incapacitating symptoms, disability, and limb loss. The arterial beds most frequently involved, in order of occurrence, are: . . . . • Femoropopliteal-tibial . . . . . . • Aortoiliac . . . . . . • Carotid and vertebral . . . . . . • Splanchnic and renal . . . . . . • Brachiocephalic . . .
The rise and fall of renal artery angioplasty and stenting in the United States, 1988-2009
