Angioplasty in the lower limb

Balloon angioplasty may be used to dilate arteries narrowed by atherosclerosis. The technique was developed first by Dotter in the 1950's and later refined by Guntzig. It involves introducing percutaneously a catheter into the artery at the end of which is a polythene balloon. Inflation of the balloon crushes the atheroma into the wall of the artery so relieving any obstruction.

The technique is effective for isolated short stenoses especially in the iliac vessels but less so for distal vessels. The patency is maintained at 2 years in about 95% of lesions above the inguinal ligament and 80% of lesions below the inguinal ligament.

Localised fibrinolytic therapy may be used as adjunct to this technique, especially if there is suggestion of recent thrombosis.

There are various interventions that may be used to prevent restenosis/reocclusion following peripheral endovascular treatment. A systematic review examined this issue (1):

• the study authors concluded that aspirin 50 to 300 mg started prior to femoropopliteal endovascular treatment appears to be the most effective and is safe treatment option. Clopidogrel might be an alternative to aspirin, but data are lacking
• abciximab might be a useful adjunctive for high risk patients with long segmental femoropopliteal interventions
• low molecular weight heparin seems to be more effective in preventing reocclusion or restenosis than unfractionated heparin

Reference:

1. Dorffler-Melly J et al. Antplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment. Cochrane Syst Rev 2005;(1):CD002071