Femoropopliteal percutaneous transluminal angioplasty for limb salvage

The role of balloon catheter femoropopliteal percutaneous transluminal angioplasty (FP PTA) continues to be controversial 14 years after its initial description. In high-risk patients with limb-threatening ischemia, the role of FP PTA is unknown. We reviewed the cases of 27 patients in whom high operative risk and advanced ischemia resulted in referral for PTA of the femoropopliteal segment. Technical and hemodynamic success rates were 74% and 52%, respectively. Patient follow-up was 3 to 84 months after PTA (mean 24 months). Nine patients (33%) had successful limb salvage for more than 12 months. The cumulative limb salvage rate was 47% at 2 years. Established prognostic criteria did not predict this subset of patients. Hemodynamic improvement after PTA did correlate closely with both early and late successful limb salvage. There were two periprocedural deaths. Morbidity included an acute arterial occlusion necessitating an emergency FP bypass and two minor complications. FP PTA is useful in selected high-risk patients with limb-threatening ischemia. Protocols to facilitate successful long-term limb salvage must include close liaison between the vascular surgeon and interventional radiologist, intensive periprocedural monitoring, and serial noninvasive hemodynamic assessment.