Outcomes of Percutaneous Transluminal Angioplasty (PTA) Done in a Minimal Resource Setting

Abstract

Introduction - With the rise of diabetes there is a significant burden of peripheral occlusive arterial disease in Sri Lanka 1. Percutaneous transluminal angioplasty is a treatment modality for occlusive arterial disease applicable even in high risk patients unfit for open surgery. We present the 3-year results of a prospective study of PTA which is the first series of patients done in Sri Lanka by vascular surgeons. All the cases were done using only non drug coated balloons in a minimal resource setting Methods - All patients (162) who had tissue loss that were deemed non-healing who underwent PTA between 2013 January to October 2016 were studied prospectively. Data of patients were collected using a standard questionnaire and the data entered into a computerized database. Patients were followed up using telephone interviews with regard to limb salvage and survival. The statistical analysis of determining long term results were done using Kaplan-Meier method (product-limit method) for univariate analysis and it was used to estimate the Survival rate, Amputation Free Survival and Death censored Limb Salvage. Results - Between January 2013 and October 2016, 162 patients (median age 66.5 years, range 29-95: 93 men) were treated with PTA . The percentage of patients with Diabetes, Hypertension and IHD are 92%, 56%, 36% respectively. The initial radiological success rate is 85.1%. Acute complications (<30 days) were developed in 6.7% (11/162) of patients and that includes a single mortality. The Kaplan-Meier method was used to calculate Survival rate, Amputation free survival and death censored limb salvage in this study. Patient Survival rates, Amputation Free Survival and Death Censored Limb Salvage rates were calculated for up to 3 years and shown in table 1. The mortality rate at 1, 12, 24 and 36 months were 11%, 28%, 33% and 33% respectively. The death censored limb salvage rate at 1, 12, 24 and 36 months were 87%, 78%, 76% and 76% respectively. The amputation free survival at 1, 12, 24, 36 months were 79%, 55%, 50% and 50% respectively. Conclusion - Death censored limb salvage 76% at three years is comparable to units in high resource settings2 despite lack of stents and drug coated balloons. Our early results justify the use of PTA in suitable patients, and further follow up is required to assess long term limb salvage. The overall mortality is higher giving a low amputation free survival.