Arterial perforation during infrainguinal lower limb angioplasty does not worsen outcome: results from 1409 patients

To assess the prevalence and clinical significance of arterial perforation during lower limb angioplasty and determine the outcome of patients suffering this complication.

The radiology department records of 1409 patients (878 men; mean age 69.6 years) undergoing peripheral angioplasty in 1532 limbs between January 1996 and December 1998 were studied to identify patients with a perforated vessel.

Fifty-two (3.7%) perforations occurred. Patients with a perforation were significantly older (median 74.8 years versus 69.6, p=0.03) and were more likely to be diabetic (p=0.01). The median age of a smoker with a perforation was 68 years versus 78 years for nonsmokers (p=0.02). Among the perforations, 29 resolved without intervention, 6 required temporary balloon occlusion, 15 were coil embolized, and 2 needed both balloon and coil treatment. Twenty-four (46%) of the 52 patients had a clinically successful angioplasty despite the perforation. No patient needed further urgent intervention. Seven patients underwent subsequent surgery to treat the underlying vascular disease that had prompted treatment initially; no one was treated for complications of the perforation. Due to the more extensive nature of the procedure, subintimal angioplasty was associated with an unsurprising increase in the rate of perforation (RR, 2.06; 95% CI, 1.19-3.56; p=0.01). In no case did the perforation prejudice the eventual outcome of the patient.

Arterial perforation during angioplasty is more common in the elderly and in diabetics. The perforation itself does not influence the ultimate outcome of the case; rather, it is the underlying vascular pathology.