The place of percutaneous transluminal angioplasty in the treatment of patients having angiography for ischaemic disease of the lower limb

A prospective survey was made during 1 year of all 226 patients having angiography for lower limb ischaemia, to assess the accuracy of selection for angiography and the current treatment of the disease. Sixty-two percent of the patients presented with intermittent claudication and were found to have a fall in ankle systolic blood pressure on exercise. Thirty-one percent had rest pain or ischaemic skin changes. All patients had abnormal angiograms, with aorto-iliac disease present in 42%, combined with distal disease in 22%. There was a normal aorto-iliac segment in 58% of patients who had more distal disease. Calf-vessels only were affected in 15%. Treatment was by surgery only in 49%, and balloon dilatation only in 19%. A further 2% had dilatation as a complement to surgery, and 6% had surgery when dilatation failed or had complications. Dilatation was attempted unsuccessfully in 6%. No treatment was offered to 20% of patients. It is concluded that selection of patients for angiography using clinical and vascular laboratory assessment avoids unnecessary examinations and that approximately one-third of these selected patients are candidates for angioplasty, which is the preferred first option for treatment in all suitable patients.