Management of angioplasty complications, unsuccessful procedures and early and late failures.

Limb-salvage was the indication for 90% of 206 attempted PTAs in 175 patients between 1976 and 1982. Life-table patency rates at 4 years for the angiographically successful iliac PTA and femoropopliteal PTA were 78% and 50%, respectively. PTA of eight iliac, seven femoropopliteal, nine tibial, and two subclavian arteries and one autogenous saphenous vein graft (ASV) were unsuccessful. Of these, 17 subsequently underwent successful bypass grafts and five required below-knee amputations. Ten iliac, 37 femoropopliteal, four tibial, and two ASV graft PTAs failed. Of 20 repeat attempts at PTA, only two have achieved long-term patency. Appropriate surgery allowed limb salvage in 23 of 36 early failures (less than 3 months) and 12 of 14 late failures (greater than 3 months), and usually consisted of the same operation that would have been performed had PTA not been attempted. Fifty-two complications were classified according to the method of treatment. Fourteen warranted surgery, but in 10 this was successfully achieved by the same operation that would have been required had PTA not been performed.