Complications after percutaneous transluminal angioplasty

Percutaneous transluminal angioplasty is being widely advocated as an alternative to direct arterial reconstructive surgery. Distressing complications of percutaneous transluminal angioplasty have been noted, including anterograde dissection of the femoral and iliac arteries with acute thrombosis and widespread embolization of the mesenteric and peripheral circulation leading to death, thrombosis and embolization of the renal arteries with infarction of the kidney and thrombosis of the popliteal trifurcation. While percutaneous transluminal angioplasty promises to be a useful adjunct to our vascular armamentarium in properly selected poor risk patients, we do not believe that it is safer than reconstructive surgery. The most suitable lesions for dilatation appear to be flat, solitary atheromas and segmental scars, which comprise only a small percentage of the total spectrum of the atherosclerosis. An alternative approach to percutaneous transluminal angioplasty entails the combined efforts of the angiographer and surgeon utilizing fluoroscopic guidance and surgical exposure of the affected vessel in the operating room. We hope that employment of the latter technique will result in more selective application of transluminal angioplasty with fewer complications and better long-term results.