Hemodynamic assessment of transluminal angioplasty for lower extremity ischemia.

The results of percutaneous transluminal angioplasty (PTA) for 56 ischemic lower extremities in 51 patients were analyzed. Indications for balloon catheter dilatation were intermittent claudication in 46 limbs (82.1%), rest pain in five (8.9%), and ischemic ulceration in five (8.9%). Balloon dialation was technically successful in 16 of 17 iliac segment lesions (94.1%) with symptomatic improvement in each instance. Nine of the 16 limbs were hemodynamically improved with a significant increase (less than 0.15) in ankle systolic pressure index. Four additional limbs had improvement in the thigh index. The remaining three limbs were hemodynamically unimproved. During average follow-up of 7.1 months, the 13 initially improved limbs remained hemodynamically improved. Thirty-one of 42 femoropopliteal dilatations (73.8%) were technically successful, with uniform symptomatic improvement. Of these 31 limbs, 26 had a significant initial increase in ankle index, one had improvement in distal thigh index only, and the remaining four limbs were hemodynamically unimproved. During mean follow-up of 8.4 months in the 27 limbs that initially were improved after femoropopliteal dilation, the pressure index returned to the pre-PTA level in 12 instances (44.4%). These results indicate that PTA is useful in selected short-segment iliac lesions. Balloon dilation of femoropopliteal lesions was less successful and its application requires further evaluation. This study demonstrates the need for close monitoring of the objective hemodynamic response, as well as symptomatic and angiographic results, in establishing the proper role of PTA in the treatment of lower extremity ischemia.