Results of surgery and angioplasty for the treatment of chronic severe lower limb ischaemia

Objective: The aim of this study was to assess and compare the efficacy of PTA and surgery in the treatment of severe lower limb ischaemia. Design: Prospective 12-month study of 180 consecutive patients with severe chronic lower limb ischaemia. Methods: PTA was used as first line therapy whenever possible and appropriate. Surgical revascularisation, primary amputation and conservative therapy were used in the remaining patients. Patient survival and limb salvage were derived using life table analysis. Results: Revascularisation was attempted in 135 (75%) patients, with PTA in 82 (46%), surgery in 49 (27%) and a combination of both in four (2%). Overall 12-month survival and limb salvage was 75% and 71%, respectively. Surgery and PTA had significantly higher survival rates (91% and 78%) than primary amputation or conservative therapy (57% and 52%) (p<0.0001 log rank test). Revascularisation with either surgery or PTA achieved the same limb salvage rate of 76% Conclusion: A large proportion of patients with severe chronic lower limb ischaemia can be managed by PTA. This management strategy produces a clinically effective outcome at 1-year.