Hsien-Li Kao, MD
Assistant Professor, Clinical Cardiology
Director, Cardiac Cath Lab
National Taiwan University Hospital

With aging of the population and life style changes, the incidence of
atherosclerotic arterial steno-occlusive diseases has increased significantly over the past decades. As patient awareness and diagnostic tools improve, more and more peripheral arterial diseases can be picked up in a relatively early clinical status. The therapeutic goal is therefore not only to correct the disorder itself, but also decrease the morbidity and discomfort that is induced by the treatment. With the wide success of percutaneous endoluminal intervention in the coronary vasculature, the same minimally invasive approach has been adapted in the management of peripheral arterial diseases.
Cerebral vascular diseases, especially extracranial carotid artery stenosis and vertebral artery stenosis, can be successfully treated by endovascular intervention. With use of vascular stents and embolic protection devices, the procedural as well as long-term results are proven to be equal or even superior to conventional surgical treatment. The indication and exemplary cases will be presented and discussed.
Limb arterial insufficiency is another major field of endovascular intervention. Intermittent claudication impairs life quality, and ischemic tissue loss not only causes suffering but also increase mortality. Treatment planning combining pharmacological, interventional, and surgical approaches is essential in the management of these patients. Clinical evaluation and treatment of exemplary cases will also be presented.
Renal artery stenosis with subsequent renovascular hypertension and ischemic nephropathy is frequently ignored by clinician, leading to unnecessary medication or even dialysis. Endovascular intervention has been proven to improve blood pressure control, and stabilization of renal function. The importance of clinical alert, choice of adequate diagnostic modality, and timely referral for treatment is shown in a real case.
Abdominal aortic aneurysm is another disease subset that enjoys the benefit of advances in endovascular intervention. Stent grafting in patients with complex comorbidity effectively reduce the risk of aneurysm rupture, while avoiding the potentially high incidence of surgical complication. Thoracic aortic aneurysm and aortic dissection may also be treated with endovascular techniques in the future.
Cardiovascular system is the largest organ system in the human body. As the same atherosclerotic disease process may affects all parts of the system, a global approach should be adapted in the treatment of any specific vascular territory disease.
Endovascular intervention offers less invasive but similarly effective therapeutic option to conventional surgery, and its wide application is expected in the near future.
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