A PROGRAM OF OPERATIVE ANGIOPLASTY - ENDOVASCULAR INTERVENTION AND THE VASCULAR SURGEON

Purpose: Vascular surgeons are ideally suited to select and perform en dovascular interventions either as primary therapy or as an adjunct to bypass surgery. Attaining proficiency in endovascular techniques is a n important goal in the training of vascular surgeons. We report our i nitial experience with a program of endovascular intervention performe d in the operating room by vascular surgeons. Methods: During the prev ious three years, we performed 109 angioplasty procedures, 60 aortoili ac (55%), 32 femoropopliteal (29%), and 17 popliteal/tibial (16%), usi ng guidewires and angioplasty balloons directed by intraoperative digi tal subtraction C-arm arteriography with road-mapping capabilities. In dications for angioplasty included disabling claudication in 59 patien ts (54%), rest pain in 18 (17%), and tissue loss in 32 (29%). Angiopla sty was accompanied by stent placement in 39 of 60 aortoiliac procedur es (65%) and in two of 32 femoral procedures (6%). In 16 cases (15%), the endovascular procedure was performed in conjunction with a bypass procedure. In selected cases (15, 14%), duplex scanning was the sole d iagnostic method used before surgery to identify the lesion, eliminati ng the need for preoperative arteriographic scans. Segmental pressure measurements, duplex ultrasound scans, and treadmill exercise testing as indicated were performed before and after surgery. The efficacy of the endovascular intervention was assessed at 3-month intervals during the first year and at 6-month intervals thereafter. Results: A succes sful result was defined using criteria recommended by the Ad Hoc Subco mmittee on Reporting Standards for Endovascular Procedures from the So ciety for Vascular Surgery/International Society for Cardiovascular Su rgery. This included the combination of symptomatic improvement, obtai ning an anatomically successful result with <30% residual lumen stenos is, and elimination of the translesion gradient with an improvement in high thigh-brachial index or ankle-brachial index greater than 0.15. Initial success was achieved in 55 of 60 aortoiliac (92%), 28 of 32 fe moropopliteal (88%), and 16 of 17 popliteal/tibial (94%) angioplasty p rocedures. Clinical follow-up has been achieved in all cases, with con tinued clinical success rates of 80%, 75%, and 82% for aortoiliac, fem oropopliteal, and popliteal/tibial angioplasty procedures, respectivel y, with a mean follow-up of 15.7 months. Conclusion: These results con firm the value of a program in which C-arm technology was used by vasc ular surgeons in the performance of angioplasty and stenting procedure s in the operating room. This experience in therapeutic endovascular i ntervention will facilitate the credentialing process for future vascu lar surgeons.