Balloon angioplasty by vascular surgeons

Abstract

Endovascular treatment of arterial disease of the lower extremity is performed by radiologists, cardiologists, and some vascular surgeons. This retrospective review was performed to measure complications and success rates in patients with extensive occlusive disease treated by vascular surgeons. Balloon angioplasties were performed on 336 vascular segments as a part of 239 lower extremity revascularization procedures in 200 patients between April 1990, and May 1996. Immediate technical success was determined by completion angiography, measurement of pressure gradients, or ankle brachial indices (ABI) within 30 days. Late technical success was determined by duplex imaging or ABI. Late clinical success was defined as relief of presenting symptoms. Indications for intervention included claudication (51%), limb threat (45%), and failing grafts (4%). Sixty-one percent of the endovascular procedures were performed open, and 39% were percutaneously performed. Stents were utilized at 17% of the angioplasty sites. Procedures involved angioplasty of multiple arterial sites in 117 cases (55%), angioplasty combined with open surgical bypass (endarterectomy or thrombectomy) in 65 cases (19%), and a combination of surgery with a second angioplasty in 43 (13%). Complications occurred in 9 cases (3%). There were 2 deaths within 30 days (0.5%). Immediate technical success was 93% (140 of 151) for all aortoiliac segments, 88% (75 of 85) for femoral segments, 92% (54 of 59) for popliteal, and 84% (21 of 25) for tibials. The late technical success was 81% (118 of 145) for aortoiliac segments, 67% (55 of 82) for femoral, 73% (41 of 56) for the popliteals, and 75% (18 of 24) for the tibial segments. These data demonstrate that balloon angioplasty can be performed effectively by vascular surgeons with a low complication rate in a population of patients where limb salvage was a significant indication for the procedure, and treatment often required the correction of multilevel disease.