Abstract
As vascular surgeons, we performed 376 percutaneous transluminal angioplasties as follows: aorta and iliac arteries (148), infrainguinal arteries (191), and bypass grafts (21). Sixteen procedures were attempted but not completed. Neodymiumyttrium-aluminum-garnet laser thermoprobe was successfully used prior to balloon dilatations in 49 procedures. In contrast to our experience with operative intervention, percutaneous transluminal angioplasty was performed more frequently for claudication (75%), nondiabetics (72%), and women (45%). Median age was 71 years. Percutaneous transluminal angioplasty either preceded or followed proximal or distal open reconstruction in 58 extremities. Primary patency rates for iliac percutaneous transluminal angioplasties were: 94% at one month, 93% at six months, and 88% at one year. For infrainguinal percutaneous transluminal angioplasties they were 95%, 82%, and 70% at 1, 6, and 12 months, respectively. Repeat percutaneous transluminal angioplasty increased the one-year patency rates to 92% and 86% for iliac and infrainguinal percutaneous transluminal angioplasties, respectively. Preliminary data indicate that the six-month secondary patency rates were 82% for laser-assisted percutaneous transluminal angioplasty and 65% for percutaneous transluminal angioplasty of distal bypass grafts. The implementation of balloon angioplasty was facilitated by our 21 years of experience with arteriography. Percutaneous transluminal angioplasty has become a valuable adjunct to the practice of vascular surgery by expanding the therapeutic options for managing peripheral vascular occlusive disease.
Similar content being viewed by others
References
ADAR R, CRITCHFIELD GC, EDDY DM. A confidence profile analysis of the results of femoropopliteal percutaneous transluminal angioplasty in the treatment of lowerextremity ischemia.J Vasc Surg 1989;10:57–67.
BOROZAN P, SCHULER J, SPIGOS D, et al. Long-term hemodynamic evaluation of lower extremity percutaneous transluminal angioplasty.J Vasc Surg 1985;2:785–793.
CAMBRIA R, FAUST G, GUSBERG R, et al. Percutaneous angioplasty for peripheral arterial occlusive disease.Arch Surg 1987;122:283–287.
HEWES R, WHITE R, MURRAY R, et al. Long-term results of superficial femoral artery angioplasty.AJR 1986;146:1025–1029.
HOWD A, SPENCER H, LOOSE H, et al. The widening indications for transluminal angioplasty in peripheral vascular disease.Inter Angio 1986;5:275–279.
JOHNSTON K, RAE M, HOGG-JOHNSTON S, et al. 5-year results of a prospective study of percutaneous transluminal angioplasty.Ann Surg 1987;206:403–413.
KADIR S, WHITE R, KAUFMAN S, et al. Long-term results of aortoiliac angioplasty.Surgery 1983;94:10–14.
MURIE J. Percutaneous transluminal angioplasty and vascular surgery for lower limb ischaemia.Br J Surg 1988;75:1051–1052.
SALLES-CUNHA S, ANDROS G, DULAWA L, et al. Changes in peripheral hemodynamics after percutaneous transluminal angioplasty.J Vasc Surg 1989;10:338–342.
SCOBIE T. Presidential address, 1986. Current status of transluminal angioplasty.Can J Surg 1987;30:175–178.
SPENCE R, FREIMAN D, GATENBY R, et al. Long-term results of transluminal angioplasty of the iliac and femoral arteries.Arch Surg 1981;116:1377–1386.
WALTMAN A, GREENFIELD A, NOVELLINE R, et al. Transluminal angioplasty of the iliac and femoropopliteal arteries.Arch Surg 1982;117:1218–1221.
WRIGHT J, BELKIN M, GREENFIELD A, et al. Laser angioplasty for limb salvage: observations on early results.J Vasc Surg 1989;10:29–38.
ZEITLER E. Transluminal catheter dilatation: indications, technical aspects, results.Inter Angio 1986;5:137–150.
GRUNTZIG A, KUMPE D. Technique of percutaneous transluminal angioplasty with the Gruntzig balloon catheter.AJR 1979;132:547–552.
PERLER BA, OSTERMAN FA, WHITE RI Jr, et al. Percutaneous laser probe femoropopliteal angioplasty: a preliminary experience.J Vasc Surg 1989;10:351–357.
SEEGER JM, ABELA GS. Laser angioplasty of iliofemoral and distal arteries. In: BERGAN JJ, YAO JST (Eds).Techniques in Arterial Surgery. Philadelphia: WB Saunders, Co., 1990, pp 399–405.
SANBORN TA. The use of thermal-tip laser probe in occluded arteries. In: BERGAN JJ, YAO JST (Eds).Arterial Surgery: New Diagnostic and Operative Techniques. Orlando: Grune & Stratton, Inc., 1988, pp 69–77.
GINSBURG R. Laser angioplasty as an adjunct to balloon dilatation. In: MOORE WS, AHN SS (Eds).Endovascular Surgery. Philadelphia: WB Saunders, Co., 1989, pp 389–392.
RUTHERFORD R, FLANIGAN D, GUPTA S, et al. Suggested standards for reports dealing with lower extremity ischemia.J Vasc Surg 1986;4:80–94.
MORIN J, JOHNSTON K, RAE M. Improvement after successful percutaneous transluminal dilation treatment of occlusive peripheral arterial disease.Surg Gynecol Obstet 1986;163:453–457.
SAMSON R, SPRAYREGEN S, VEITH F, et al. Inadequacy of the noninvasive hemodynamic evaluation of percutaneous transluminal angioplasty.Am J Surg 1984;147:212–215.
WALDEN R, SIEGEL Y, RUBINSTEIN Z, et al. Percutaneous transluminal angioplasty: a suggested method for analysis of clinical, arteriographie, and hemodynamic factors affecting the results of treatment.J Vasc Surg 1986;3:583–590.
JANEVSKI B, BRESLAU P, JORNING P. More accurate assessment of stenotic lesions in percutaneous transluminal angioplasty.Inter Angio 1986;5:97–103.
WEIBULL H, BERGQVIST D, JONSSON K, et al. Complications after percutaneous transluminal angioplasty in the iliac, femoral, and popliteal arteries.J Vasc Surg 1987;5:681–686.
DOUBILET P, ABRAMS H. The cost of under utilization: percutaneous transluminal angioplasty for peripheral vascular disease.N Engl J Med 1984;310:95–102.
FREIMAN D, FREIMAN M, SPENCE R, et al. Economic impact of transluminal angioplasty.Angiology 1985;36:772–777.
SIMPSON J, SELMON M, ROBERTSON G, et al. Transluminal atherectomy for occlusive peripheral vascular disease.Am J Cardiol 1988;61(14):96G-101G.
CUMBERLAND D, TAYLER D, WELSH C, et al. Percutaneous laser thermal angioplasty: initial clinical results with a laser probe in total peripheral artery occlusions.Lancet 1986;June 18:1457–1459.
SEEGER J, ABELA G, SILVERMAN S, et al. Initial results of laser recanalization in lower extremity arterial reconstruction.J Vasc Surg 1989;9:10–17.
SIGWART U, PUEL J, MIRKOVITCH V, et al. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty.N Engl J Med 1987;316:701–706.
WALKER W, GIDDINGS A. A protocol for the safe treatment of acute lower limb ischemia with intra-arterial streptokinase and surgery.Br J Surg 1988;75:1189–1192.
AUSTER M, KADIR S, MITCHELL S, et al. Iliac artery occlusion: management with intrathrombus streptokinase infusion and angioplasty.Radiology 1984;153:385–388.
JONES B, MAGGISANO R, ROBB C, et al. Transluminal angioplasty: results in high-risk patients with advanced peripheral vascular disease.Can J Surg 1985;28:150–152.
KOROGI Y, TAKAHASHI M. Percutaneous transluminal angioplasty of totally occluded iliac artery in high-risk patients.Br J Radiol 1986;59:1167–1170.
PILLA T, PETERSON G, TANTANA S, et al. Percutaneous recanalization of iliac artery occlusions: an alternative to surgery in the high-risk patient.AJR 1984;143:313–316.
GRAZIANI L. Percutaneous recanalization of total iliac and femoro-popliteal artery occlusions.Eur J Radiol 1987;7:91–93.
COLAPINTO R, STRONELL R, JOHNSTON W. Transluminal angioplasty of complete iliac occlusions.AJR 1986;146:859–862.
VAN ANDEL G. Long-term results of iliac and femoral angioplasty.Annales de Radiologie 1981;24:365–368.
ANDROS G, HARRIS R, SALLES-CUNHA S. Technique of intraoperative balloon angioplasty. In: MOORE WS, AHN SS (Eds).Endovascular Surgery. Philadelphia: WB Saunders Co, 1989, pp 209–222.
ANDROS G, HARRIS R, DULAWA L, et al. Balloon angioplasty of iliac, femoral, and infrainguinal arteries: percutaneous and intraoperative strategies and techniques. In: BERGAN JJ, YAO JST (Eds).Techniques in Arterial Surgery. Philadelphia: WB Saunders Co, 1990, pp 381–398.
ZEITLER E, RAITHEL D, GAILER H, et al. PTA combined with surgical vascular operations in iliac and femoral obstruction.Ann Radiol 1987;30:142–144.
BUNT T. Aortic reconstruction vs extra-anatomic bypass and angioplasty: thoughts on evolving a protocol for selection.Arch Surg 1986;121:1166–1171.
TISNADO J, VINES F, BARNES R, et al. Percutaneous angioplasty following endarterectomy.Radiology 1984;152:361–364.
GREENSPAN B, PILLARI G, SCHULMAN M, et al. Percutaneous transluminal angioplasty of stenotic deep vein arterial bypass grafts.Arch Surg 1985;120:492–495.
COHEN J, MANNICK J, COUCH N, et al. Recognition and management of impending vein-graft failure.Arch Surg 1986;121:758–759.
VEITH F, WEISER R, GUPTA S, et al. Diagnosis and management of failing lower extremity arterial reconstructions prior to graft occlusion.J Cardiovasc Surg (Torino) 1984;25(5):381–384.
SCHMIDTKE L, ROTH F. Repeated percutaneous transluminal catheter-treatment: primary results.Inter Angio 1985;4:87–91.
SAMSON R, SPRAYREGEN S, VEITH F, et al. Management of angioplasty complications, unsuccessful procedures and early and late failures.Ann Surg 1984;199:234–240.
BLOCK P, ELMER D, FALLON J. Release of atherosclerotic debris after transluminal angioplasty.Circulation 1982;65:950–952.
KUMPE D, ZWERDLINGER S, GRIFFIN D. Blue digit syndrome: treatment with percutaneous transluminal angioplasty.Radiology 1988;166:37–44.
BREWER M, KINNISON M, PERLER B, et al. Blue toe syndrome: treatment with anticoagulants and delayed percutaneous transluminal angioplasty.Radiology 1988;166:31–36.
Author information
Authors and Affiliations
About this article
Cite this article
Harris, R.W., Dulawa, L.B., Andros, G. et al. Percutaneous transluminal angioplasty of the lower extremities by the vascular surgeon. Annals of Vascular Surgery 5, 345–353 (1991). https://doi.org/10.1007/BF02015295
Issue Date:
DOI: https://doi.org/10.1007/BF02015295