Angioplastia transluminal percutánea del sector femoropoplíteo distal en la isquemia crítica

Summary Introduction Revascularisation by means of a venous bypass is the therapy of choice in critical limb ischemia. The aim of this work is to analyse in a selected group of patients whether percutaneous transluminal angioplasty (PTA), which is considered to be a controversial method, can be used as an effective option, either alone or associated with surgery for the salvage of a limb Patients and methods Up to May 2002 an analysis was conducted of the results of PTA carried out between 1996-1999 on 60 patients with critical ischemia, 66 procedures; 93 PTA; 36 males; 24 females; mean age 74 (interval: 46-94). Localisation: superficial femoral: 47; popliteal: 26; femoropopliteal: 4; distal: 13; stenosis of venous bypass: 3. Angiographic selection: short or joint severe stenoses Results Technical success rate 94%; four failures in 66 procedures. There were 13 (19.7%) complications; 11 small; two major that required a bypass (one acute thrombosis, one large dissection); one exitus before 30 days due to mesenteric ischemia. During the follow-up three new PTA were performed; 10 (16.6%) bypass interventions; eight (13.3%) major amputations. Limb salvage rate due to PTA alone or in association with surgery was 86.7%. Primary patency rate at 6, 12, 24 and 60 months was 71, 61, 55 and 39%, respectively. Mortality rate throughout the follow-up was 41.6%. Conclusions When short injuries are selected, the results regarding late patency obtained by using PTA are modest, but it provides excellent results with respect to limb preservation at five years. PTA failure does not prevent a bypass from being performed later in order to save a limb.