Impact of angioplasty on infrainguinal bypass for critical ischaemia of the leg

Background: Both angioplasty and infrainguinal bypass procedures may be used to achieve limb salvage in patients with critical ischaemia. The authors investigated the effect of the introduction of angioplasty on the frequency with which infrainguinal bypass was performed and, second, the changes in outcome of infrainguinal bypass following the introduction of angioplasty. Methods: All patients had critical ischaemia of the leg. Three patient groups were studied: 215 patients undergoing infrainguinal bypass before the introduction of angioplasty (1986–1991), 216 patients who had infrainguinal bypass after the introduction of angioplasty (1993–1998) and 193 patients undergoing angioplasty in the same 5-year interval (1993–1998). Results: The age and risk profile of the three groups was identical. The overall caseload increased by 19 per cent following the introduction of angioplasty. Primary and secondary patency rates were superior for bypass compared with angioplasty, but were similar for the two bypass groups (5-year primary patency rate 60 per cent versus 18-month primary patency rate 45 per cent; 5-year secondary patency rate 80 per cent versus 18-month secondary patency rate 60 per cent). By 18 months 26 per cent of patients having angioplasty had gone on to have bypass. The limb salvage rate of 90 per cent at 1 year was similar for all groups. Survival was significantly higher in the group of patients undergoing bypass from 1993 to 1998 compared with the other two groups (80 versus 60 per cent; P < 0·0002). Conclusion: The introduction of angioplasty has increased overall workload. Angioplasty has a lower patency rate than bypass but a comparable limb salvage rate, making it a suitable alternative to bypass in the management of patients with critical ischaemia. © 2001 British Journal of Surgery Society Ltd