Acute surgical intervention for complications of percutaneous transluminal angioplasty

Since 1979, percutaneous transluminal angioplasty (PTA) resulting in an overall improvement of 80.3% has been performed in 4380 patients with occlusive atheroma of the lower extremities. Complications requiring immediate surgical treatment occurred in 123 (2.8%) of the cases, consisting of occlusion (16%), dissection (13%), perforation (10%), embolisation (15%) and haematoma at the puncture track (69%). Of the group treated surgically, 18 (14.6%) patients underwent amputation of a lower limb. Since 1980 348 percutaneous transluminal coronary angioplasties (PTCAs) have been performed for coronary artery disease. In 15 cases (4.3%) emergency coronary bypass surgery was necessary because of complications encountered with PTCA. Two patients died and perioperative myocardial infarction occurred in 7 (subendocardial-3: transmural-4). In spite of a low complication rate and good results from PTA and PCTA acute surgical intervention for complications carries a significant operative morbidity and mortality. We conclude that selection for PTA and PTCA has to involve vascular and cardiac surgeons, their presence being mandatory at institutions in which therapeutic radiological procedures are undertaken.