Techniques for the endovascular management of complications following lower limb percutaneous transluminal angioplasty

Abstract

although early complications occur in 14% of limbs undergoing percutaneous transfemoral angioplasty, the majority (97%) can be managed by endovascular techniques.

When is a technically successful peripheral angioplasty effective in preventing above‐the‐ankle amputation in diabetic patients with critical limb ischaemia?

“…During the procedure, a sodium heparin (5000–7000 IU) bolus was infused into the arterial lumen; if vessel spasm occurred, a nitroglycerine (0.1–0.2 mg) bolus was infused intra‐arterially. The occurrence of thrombi was managed by catheter aspiration and/or urokinase and heparin infusion [12]. All patients were prescribed ticlopidine 500 mg/day for 30 days followed by aspirin 100 mg/day indefinitely.…”

Multicentre randomised controlled trial of the clinical and cost-effectiveness of a bypass-surgery-first versus a balloon-angioplasty-first revascularisation strategy for severe limb ischaemia due to infrainguinal disease. The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial

“…Pros Superior long-term anatomic patency and clinical durability [4][5][6] Low morbidity and mortality and requirement for urgent surgical intervention 7 Low cost Quick to perform Shorter hospital stay Can be repeated Failed angioplasty may not jeopardise subsequent surgery 7 Preserves collaterals so that even if the angioplasty site occludes symptoms may not return and tissue loss may remain healed 8,9 Cons Significant morbidity and mortality 10 Significant resource utilisation (theatre time and personnel, prolonged hospital stay) Graft surveillance, often leading to repeated prophylactic reintervention, required to optimise patency 11,12 Vein as a conduit often unavailable, inadequate in length or poor quality 13 Use of prosthetic material associated with poorer patency and risk of graft infection 4…”

“…Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy.…”

Results for primary bypass versus primary angioplasty/stent for lower extremity chronic limb-threatening ischemia

“…1–4 Support for balloon angioplasty, on the other hand, highlights the benefits of lower procedural morbidity and mortality, faster procedural times, and a reduced hospital stay. 5 Proponents of PTA/S additionally claim that failed angioplasty does not threaten successive surgery and preserves collaterals; however, recent data have not only proven otherwise, but have also illustrated higher rates of restenosis. 6–9 …”