SHOULD BALLOON ANGIOPLASTY AND STENTS HAVE ANY ROLE IN OPERATIVE INTERVENTION FOR LOWER-EXTREMITY ISCHEMIA

Balloon angioplasty has been combined with open vascular surgery to tr eat lower extremity ischemia due to multilevel occlusive disease. The purposes of this study were: (1) to compare staged and simultaneous ap proaches to determine the optimal method for combining endovascular an d open techniques and; (2) to assess the role of stents in intraoperat ive balloon angioplasty. Among 274 patients undergoing lower extremity revascularization over 30 months, 38 (13.9%) required a combination o f endovascular and open techniques; 17 were staged (endovascular follo wed at an interval by distal open surgery) and 21 were simultaneous (i ntraoperative balloon angioplasty with or without stent placement at t he time of open surgery). Groups were similar with respect to demograp hics, lesions treated with endovascular intervention, incidence and lo cation of stent placement, and results of surgery. Additional operatin g time required for intraoperative endovascular intervention was 41.0 +/- 30.7 min., fluoroscopic time was 3.9 +/- 2.4 min. and contrast adm inistered was 58.8 +/- 28.1 mi. There was no perioperative mortality. Length of stay was longer in the staged than in the simultaneous group (p < 0.01). Cumulative combined primary patency at 1 year by life-tab le methods was 82 +/- 10% in the staged group and 83 +/- 9% in the sim ultaneous group (p = 0.79). Mean follow-up was 13 +/- 6 months. There is a role for balloon angioplasty and stent placement in operative rev ascularization of ischemic limbs in selected patients: patency was sim ilar to that produced with the staged approach while the length of sta y was shorter. Intraoperative balloon angioplasty is safe and effectiv e and stents permit a measure of control in assuring an optimal intrao perative postangioplasty result.