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

Abstract

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.