The increasing role of percutaneous transluminal angioplasty in the primary management of critical limb ischaemia

Objective: to review the current role and results of angioplasty in the management of critical limb ischaemia (CLI) in a single institution. Methods: data on 526 patients with 608 ischaemic limbs, treated between January 1994 and December 1999 was collected prospectively and analysed retrospectively. Patients were divided into 3 groups according to the date of presentation: group 1 (1994-95), group 2 (1996-97) and group 3 (1998-99). The groups were comparable in terms of demographics, mode of presentation and level of disease. Results: Revascularisation was attempted in 87%, 81% and 91% for groups 1, 2 and 3 respectively (NS). Primary percutaneous transluminal angioplasty (PTA) rates increased front 44% (1994-95) to 69% (1998-99) (p < 0.001), and surgical revascularisation rates decreased correspondingly (p < 0.01). Overall cumulative patient survival and limb salvage rates were 82% and 89% for I year and 45% and 87% for 5 years, respectively. NO statistically significant difference existed between the three groups regarding patient survival, limb salvage rates and mean hospital stay (19, 12 and 12 days, respectively). Conclusion: PTA is increasingly replacing bypass surgery in the treatment of CLI, without compromising patient survival or limb salvage rates.