Vascular surgeon's experience with intraoperative angioplasty

Intraoperative balloon angioplasty as an adjunct to vascular reconstruction is controversial and radiologists suggest that it may be less effective than preoperative or postoperative percutaneous transluminal angioplasty. The aim of the present study was to explore the role of intraoperative balloon angioplasty as performed by a vascular surgeon.

The notes and angiograms of 63 patients on whom 67 intraoperative angioplasty/stenting procedures were performed were retrieved using a computerized prospective audit system.

Although 41 procedures were planned preoperatively, 26 (39%) followed intraoperative angiography. Twenty-seven were performed to improve inflow for distal reconstructions and 27 were performed to improve outflow for proximal reconstructions. Thirteen (anastomotic stenoses) followed synthetic graft thrombectomy. Twenty-seven iliac, 15 superficial femoral artery (SFA), 11 popliteal, one anterior tibial and 13 anastomotic lesions were dilated and there were four technical failures. At follow up (median: 24 months; 3-monthly duplex scan, ankle brachial pressure indices) primary patency rates by lifetable analysis were: iliac, 75%; SFA, 91%; popliteal, 82%; anastomotic, 8%.

There are situations in which intraoperative angioplasty would be advantageous and can be performed successfully by a surgeon. Because a significant proportion of procedures was unplanned and a vascular radiologist was not readily available the authors conclude that vascular surgical trainees should be trained in angioplasty techniques. However, balloon angioplasty is ineffective in treating anastomotic stenoses and surgical intervention is required for these lesions.