The role of percutaneous transluminal angioplasty following intraarterial thrombolytic therapy for limb-threatening ischemia

The purpose of this study was to evaluate the role of regional intraarteria l thrombolytic therapy (IATT) followed by percutaneous transluminal angiopl asty (PTA) in the management of acute limb-threatening ischemia. From March 1989 to July 1994, 28 of the 130 (22%) patients who underwent IATT had les ions amendable to immediate PTA. The duration of ischemia was less than sev en days in all patients. PTA was performed for multiple lesions in 15 (54%) patients to yield a total of 46 stenotic areas. Stenoses were all less tha n 5 cm in length (mean: 2.1 cm). A mean follow-up period of 17.6 months was achieved in all patients. Immediate PTA success was achieved in 25 of 28 ( 89%) patients. Primary patency rates at 6-, 12-, 18-, and 24-month interval s were 63%, 49%, 31%, and 23%, respectively. Secondary patency rates at the same time intervals were 79%, 65%, 59%, and 52%, respectively. The limb-sa lvage rate was 64% at 12 months. Secondary surgical procedures were perform ed in 12 (43%) patients at a mean interval of 336 days from time of PTA. In patients with poor run-off (zero to one vessel patent), six-month primary patency rate was 33% compared to 77% in patients with good run-off (two to three vessels patent) (P < 0.05). PTA following IATT for limb-threatening i schemia is associated with limited long-term patency rates, particularly in patients with poor run-off.