BALLOON ANGIOPLASTY BY VASCULAR SURGEONS

BACKGROUND: Endovascular treatment of arterial disease of the lower ex tremity is performed by radiologists, cardiologists, and some vascular surgeons. This retrospective review was performed to measure complica tions and success rates in patients with extensive occlusive disease t reated by vascular surgeons. METHODS: Balloon angioplasties were perfo rmed on 336 vascular segments as a part of 239 lower extremity revascu larization 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) w ithin 30 days. Late technical success was determined by duplex imaging or ABI. Late clinical success was defined as relief of presenting sym ptoms. RESULTS: Indications for intervention included claudication (51 %), limb threat (45%), and failing grafts (4%), Sixty-one percent of t he endovascular procedures were performed open, and 39% were percutane ously performed. Stents were utilized at 17% of the angioplasty sites. Procedures involved angioplasty of multiple arterial sites in 117 cas es (55%), angioplasty combined with open surgical bypass (endarterecto my or thrombectomy) in 65 cases (19%), and a combination of surgery wi th 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 8 5) 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 a ortoiliac segments, 67% (55 of 82) for femoral, 73% (41 of 56) for the popliteals, and 75% (18 of 24) for the tibial segments. CONCLUSIONS: These data demonstrate that balloon angioplasty can be performed effec tively by vascular surgeons with a low complication rate in a populati on of patients where limb salvage was a significant indication for the procedure, and treatment often required the correction of multi-level disease. (C) 1997 by Excerpta Medica, Inc.