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Management of angioplasty complications, unsuccessful procedures and early and late failures
Insights
Percutaneous transluminal angioplasty (PTA) achieved limb salvage in most cases, but bypass grafting was often necessary after PTA failure. Repeat angioplasty rarely resulted in long-term patency.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Limb salvage is a primary goal in treating peripheral arterial disease.
- Percutaneous transluminal angioplasty (PTA) is a minimally invasive option for revascularization.
Purpose of the Study:
- To evaluate the long-term outcomes of percutaneous transluminal angioplasty (PTA) for limb salvage.
- To assess the success rates and complications associated with PTA in various arterial segments.
Main Methods:
- Retrospective analysis of 206 attempted PTAs in 175 patients between 1976 and 1982.
- Life-table analysis was used to determine patency rates.
- Outcomes including limb salvage, graft patency, and complications were recorded.
Main Results:
- Angiographically successful iliac and femoropopliteal PTAs had 4-year patency rates of 78% and 50%, respectively.
- Limb salvage was achieved in 23 of 36 early PTA failures (<3 months) and 12 of 14 late failures (>3 months) with subsequent surgery.
- Repeat PTA attempts had low long-term patency rates (2 of 20).
Conclusions:
- PTA can be an effective primary treatment for limb salvage, particularly for iliac arteries.
- Bypass grafting remains a crucial option for patients with failed PTAs.
- Careful patient selection and management of complications are essential for successful limb salvage outcomes.
Abstract:
Limb-salvage was the indication for 90% of 206 attempted PTAs in 175 patients between 1976 and 1982. Life-table patency rates at 4 years for the angiographically successful iliac PTA and femoropopliteal PTA were 78% and 50%, respectively. PTA of eight iliac, seven femoropopliteal, nine tibial, and two subclavian arteries and one autogenous saphenous vein graft (ASV) were unsuccessful. Of these, 17 subsequently underwent successful bypass grafts and five required below-knee amputations. Ten iliac, 37 femoropopliteal, four tibial, and two ASV graft PTAs failed. Of 20 repeat attempts at PTA, only two have achieved long-term patency. Appropriate surgery allowed limb salvage in 23 of 36 early failures (less than 3 months) and 12 of 14 late failures (greater than 3 months), and usually consisted of the same operation that would have been performed had PTA not been attempted. Fifty-two complications were classified according to the method of treatment. Fourteen warranted surgery, but in 10 this was successfully achieved by the same operation that would have been required had PTA not been performed.