Management of Angioplasty Complications, Unsuccessful Procedures and Early and Late Failures

Abstract

Limb-salvage was the indication for 90% of 206 attempted PTA [percutaneous transluminal angioplasty] in 175 patients between 1976 and 1982. Life-table patency rates at 4 yr for the angiographically successful iliac PTA and femoropopliteal PTA were 78 and 50%, respectively. PTA of 8 iliac, 7 femoropopliteal, 9 tibial and 2 subclavian arteries and 1 autogenous saphenous vein graft (ASV) were unsuccessful. Of these, 17 subsequently underwent successful bypass grafts and 5 required below-knee amputations. Ten iliac, 37 femoropopliteal, 4 tibial and 2 ASV graft PTA failed. On 20 repeat attempts at PTA, only 2 have achieved long-term patency. Appropriate surgery allowed limb salvage in 23 of 36 early failures (< 3 mo.) and 12 of 14 late failures (> 3 mo.), and usually consisted of the same operation that would have been performed had PTA not been attempted. Complications (52) were classified according to the method of treatment. Fourteen warranted surgery, but in 10 this was successfully achieved by the same operation that would have been required had PTA not been performed.