Vascular access is usually through the femoral artery by percutaneous cannula-tion. A sheath is then placed and various guide wires are used to traverse the lesion.

• Standard solid wire with outer spiral

• Teflon coated (decrease friction)

• J wire (allow extension and retraction of J)

• Floppy tipped guide wire

• Steerable wires

• Hydrophilic wires (decreased friction) Balloon Dilatation

The balloon is placed across the lesion and inflated. This results in fracturing of the plaque enlarging the lumen. Gradients > 20 mm Hg across the lesion suggest inadequate dilatation. There is a 90% initial success rate for short segment focal lesions and a 4 year patency rate of 60-70%.

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