Peripheral vascular complications of coronary angioplasty.

Percutaneous transluminal coronary angioplasty (PTCA) is being employed with increasing frequency for the treatment of coronary artery disease. PTCA involves the use of a larger sheath and catheter assembly than does cardiac catheterization, potentially increasing the risk of injury to the peripheral vessels used for access. Over an 18-month period, 295 angioplasty procedures resulted in six major vascular injuries (2%). The peripheral vascular complications that were recognized early included thrombosis of the common or superficial femoral artery in two patients and laceration of the iliac artery in two additional cases. Late complications included one superficial femoral artery aneurysm and one common iliac vein thrombosis. All patients required emergency operation at the time of recognition of their vascular complication, and five of six required multiple operative procedures. At operation, all but one patient had severe peripheral arterial disease. There was one death, three amputations, and multiple major complications. Although persistent dysrhythmias were common, major cardiac complications were unusual. These patients had prolonged hospital stays and high hospital costs. Although the incidence of arterial complications with PTCA is low, the consequences are potentially disastrous when they occur. Greater attention to basic evaluation for arterial disease is strongly recommended before elective PTCA, and informed consent about possible extremity complications is mandatory. These untoward results, with their prolonged stays and high costs, must be considered when evaluating the results of "nonoperative" treatment of coronary artery disease.