Limb salvage in poor-risk patients using transluminal angioplasty
D. S. Rush, B. L. Gewertz, C. T. Lu, D. G. Ball and C. K. Zarins
We performed percutaneous transluminal angioplasty (PTA) in 97 limbs of 86
patients with end-stage occlusive disease in whom vascular reconstruction
was not possible. Most patients required dilation of long-segment
occlusions and/or multiple lesions. Angiographic appearance was improved in
87 limbs of 78 patients (90%). Ankle-brachial pressure index increased from
0.40 +/- 0.03 to 0.64 +/- 0.03, and increased more than 0.15 in 63% of the
limbs. Major amputation was required in 19 of the 87 limbs (22%) following
PTA. The incidence of restenosis was 19% at three months, 42% at six
months, and 57% at one year. Repeated PTA successfully maintained vascular
patency in ten limbs, and four patients have since had successful distal
bypass. Two limbs that initially improved needed amputation four to 19
months after dilatation. Follow-up ranged from one to 45 months; overall
limb salvage rate was 76%. Thus PTA can enhance limb salvage in poor-risk
patients with end-stage disease.
