Arterial perforation during lower limb percutaneous transluminal angioplasty for treating critical lower limb ischemia

Purpose To manage infrainguinal arterial perforation during percutaneous transluminal angioplasty (PTA) by different methods and to determine the incidence of occurrence of this complication in our patients. Patients and methods This study was performed on 20 patients of 295 patients with 399 lesions who developed arterial perforation during PTA for treatment of critical lower limb ischemia. Results Median age of patients was 69.5 years, with 11 (55%) males. A total of 16 (80%) patients were diabetics, 14 (70%) patients were hypertensive, and 16 (80%) patients were smokers. Overall, seven (35%) patients had rest pain and 13 (65%) patients had ulcers or gangrene. Long-time balloon inflation was done for 15 (75%) patients. It succeeded to stop bleeding in 13 patients, and two patients underwent surgical intervention. External compression was done for five patients with tibial perforation and succeeded to stop bleeding. Overall, 17 (85%) patients of 20 patients had calcifications in their arteries. The incidence of arterial perforation in our patients in relation to the total number of patients was 6.7%, and the incidence of arterial perforation in the treated lesions in relation to the total number of lesions was similar to 5%. At the end of the procedures, 18 (90%) patients had no active extravasation with forward dye flow and during the follow-up period also. The other two patients underwent surgical intervention. Conclusion PTA is a valuable option for treatment of critical lower limb ischemia. Although complications like perforation may happen, early recognition and management is crucial and mostly perforation can be managed properly by endovascular procedures.