Transluminal angioplasty performed by the surgeon in lower limb arterial occlusive disease: one hundred fifty cases

Abstract

From February 1985 through November 1988, we performed 159 transluminal angioplasty in 135 patients with arterial occlusive disease of the lower limb. The indications were claudication, 114 cases (72%) and limb salvage, 45 cases (28%). Lesions consisted of one or more critical stenoses in 142 cases (61 iliac, 69 femoropopliteal, and 12 following surgical revascularization) and single segmental occlusion in 17 cases (one iliac and 16 femoropopliteal). Angioplasty failed because the guidewire could not be inserted in nine (5.7%) cases. Angioplasty was performed intraoperatively in 44 (29%) cases and as an isolated procedure in 106 cases (71%). When performed as an isolated procedure, the percutaneous approach was preferred in 34 of the iliac lesions (73%), 28 of the femoropopliteal lesions (50%), and four of the postsurgical lesions (50%). Early postoperative mortality was 3.3% (five patients). Eight early occlusions (5.3%) were observed, two after iliac and six after femoropopliteal angioplasty. Secondary clinical surveillance and hemodynamic and venous digital angiographic follow-up detected 35 instances of stenosis (25%), 18 of which were equal to or greater than 60%. Nine occlusions occurred (6.5%), six after iliac angioplasty and three after femoropopliteal angioplasty. At 24 months, primary cumulative patency of all transluminal angioplasties was 84% and secondary patency was 89%. Transluminal angioplasty performed by the surgeon in the operating room provides good results whether performed as an isolated procedure or as a complement to surgery. The study of secondary deteriorations confirms the value of morphologic surveillance by arteriograms. Arteriography appears to be of paramount importance in the evaluation of results and the codification of indications.(ABSTRACT TRUNCATED AT 250 WORDS)