Balloon angioplasty combined with vascular surgery

Seventy-nine intra-operative balloon angioplasties were performed in 72 patients undergoing a vascular reconstructive procedure over a 7-year-period (1981 through December 1987). The primary purpose of balloon angioplasty was either to increase inflow (26 procedures) or outflow (53 procedures) in association with a planned vascular operation and to avoid more extensive operative procedures in high risk patients. Peroperative balloon angioplasty involved atherosclerotic stenotic lesions in 26 iliac, 37 femoro-popliteal and 10 crural arteries. In 6 cases distal graft anastomotic stenoses were dilated. Follow-up ranged from 2 to 78 months (mean 32.4 months). The overall initial success rate was 84.8% and five procedure related complications were seen. One iliac restenosis with distal thrombosis, two superficial femoral artery dissections, one tibial artery thrombosis necessitating below knee amputation and one distal popliteal embolus after superficial femoral artery dilatation. There were no postoperative deaths. Fifty-one patients remained asymptomatic during follow-up. One iliac, eight femoro-popliteal and two tibial arteries restenosed with or without occlusion and thrombosis. The 3-year cumulative patency rate for the iliac and femoro-popliteal angioplasties is 80.2%. Intra-operative balloon angioplasty broadens the surgical therapeutic armamentarium available to correct multiple symptomatic arterial lesions. In addition this technique offers several advantages over a two stage procedure.