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The Role of Percutaneous Transluminal Angioplasty and Femoropopliteal Bypass in Patients with Threatened Limb

Department of Surgery, University of Sydney and Westmead Hospital, Westmead, Australia

G. Fermanis

Department of Surgery, University of Sydney and Westmead Hospital, Westmead, Australia

J.M. Little

Department of Surgery, University of Sydney and Westmead Hospital, Westmead, Australia

L.Z. Kershaw

Department of Surgery, University of Sydney and Westmead Hospital, Westmead, Australia

Fifty-two patients with no history of percutaneous transluminal angioplasty (PTA) or vascular surgery presented with a threatened limb and arteriographic findings showing suitability for femoropopliteal arterial reconstruction. Twenty-seven patients were treated by PTA (Group 1) and 25 were treated by femoropopliteal bypass (Group 2). The technical success rate was 85% for PTA and 100% for surgery. The hemodynamic success rate was 63% for PTA and 88% for surgery; the mean increase in ankle systolic pressure index (ASPI) was 0.34 following PTA and 0.57 following surgery. Complications occurred in 11 % of patients following PTA and 32% of patients following surgery. Follow-up ranged from six months to five years with a mean of two years. A clinically successful result was evident in 67% of patients having PTA and 76% of oper ated patients. The overall amputation rate for Group 1 was 7.4% and for Group 2 was 20%. It is concluded that, in the management of femoropopliteal occlusive disease, surgery is more likely to be initially successful than PTA and will give rise to a greater increase in ASPI and a higher incidence of clinically successful outcome; however, because the complication rate is higher for surgery, and fail ure is more likely to lead to amputation, PTA should be considered as a first-line treatment, particularly in patients who are at increased risk for surgery.

Vascular and Endovascular Surgery, Vol. 22, No. 4, 226-230 (1988)
DOI: 10.1177/153857448802200402


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