Fate of target vessels after failed infrainguinal angioplasty, by Mohammed Elkassaby

From St James Dublin

Commentary on the opinions of endo first vs bypass first in terms of negating outflow daamage

Ojbective: to look at outflow vesel damaage

Surgeon performed angioplasties

Single centre

POBA, stenting, atherectomy all used

Failed procedure defined as a technical failures as well as reocclusion in 30 days

Divided segments up as follows:

SFA

AK pop

BK pop

Upper tibials

Lower tibial and foot.

Primary and secondary end points

724 procedures Infra inguinal

97 failed cases

Primary success 87%

FU range 26 median , 0 to 40

Most done elective

only 32% done for IC

70% were SFA angio attempts

90% were SIA

Any damanage at all was 22%

16% only to 1 segment and another 6% to more than 1 segment (out of the 5 ‘segment’ areas classified above)

Reinterventions

37% had redo angio with a 65% success

Bypass was only done in 12% cases and success rate 92%

All casuse mortality 8% over 2 years

22% failed angio ended up with major amputation.

82% of the major amputations were in those with no damage

Question from Joseph, surgeon at DGH in Scotland

Says his practice is very similar to what was presented now

Answers to my questions:

they use 18 and 14 wires for tibial, not 0035

And they use ACT to ensure optimum heparin on board.