Percutaneous angioplasty in a district general hospital: impact and implications

Over a 2-year period 147 angioplasties were performed for stenoses or occlusions above or below the inguinal ligament. Most patients had intermittent claudication. The stenosis or occlusion was successfully dilated in 88% of cases. Successful dilatation produced a good result, as determined by improvement in Doppler pressures (63%), an increase in walking distance (60%) or limb salvage (66%). There have been 15 complications. Of seven distal emboli, three required operation and four were successfully treated with intra-arterial streptokinase. In three patients, immediate occlusion of the femoral artery required urgent operation, and one patient died following intra-arterial streptokinase and subsequent angioplasty. There were three further major haematomas, one requiring suture of the puncture site. Had angioplasty not been available, about half of the patients in this series would not have had an angiogram. Many of the remainder, not being suitable for vascular reconstruction, would have been treated conservatively. Thus a new group of patients is being defined for whom interventional treatment is now appropriate, and this has important revenue implications. Percutaneous transluminal angioplasty is a safe and effective technique in carefully selected patients. Complications can occur, however, and the immediate availability of a vascular surgeon is essential.