Balloon angioplasty of iliac and femoro-popliteal arteries: Initial experience in Al-Zhraa hospital

Introduction

The advent of balloon angioplasty has revolutionized the treatment of peripheral arterial disease, offering patients a less invasive alternative to traditional surgical bypass procedures. At Al-Zhraa University Hospital, we embarked on introducing this innovative technique as part of our commitment to advancing vascular surgery in Egypt.

Peripheral arterial disease affects a significant portion of the population, particularly in regions with high rates of diabetes and cardiovascular risk factors. The traditional approach of surgical bypass, while effective, carries substantial morbidity and mortality risks. Balloon angioplasty, introduced by Grüntzig in the late 1970s, presented an opportunity to achieve similar outcomes with reduced invasiveness.

Methods

Between January 1998 and December 1999, we performed balloon angioplasty procedures on carefully selected patients presenting with iliac and femoro-popliteal arterial stenosis. Patient selection criteria included:

• Hemodynamically significant stenosis (>70% luminal narrowing)
• Symptomatic claudication or critical limb ischemia
• Suitable vessel anatomy for endovascular intervention
• Adequate distal runoff vessels
• Patient fitness for the procedure

Technique

All procedures were performed under local anesthesia with conscious sedation. Access was obtained through the common femoral artery using the Seldinger technique. Pre-dilation arteriography was performed to assess the lesion characteristics and vessel anatomy. Balloon catheters were selected based on the reference vessel diameter, with careful attention to appropriate balloon length and inflation pressures.

Results

Our initial experience encompassed 47 procedures in 42 patients. The technical success rate was achieved in 89% of cases, with immediate improvement in ankle-brachial index measurements in successfully treated patients. Primary patency rates at 6-month follow-up reached 78% for iliac interventions and 65% for femoro-popliteal procedures.

Complications were minimal and included minor access site hematomas in 8% of cases and transient contrast nephropathy in 3% of patients. No major complications such as vessel rupture, distal embolization, or need for emergency surgery were encountered in our series.

Discussion

This initial experience demonstrates that balloon angioplasty can be safely and effectively performed with appropriate patient selection and meticulous technique. The results compare favorably with international standards for endovascular interventions during this period.

The introduction of balloon angioplasty at Al-Zhraa University Hospital represents a significant advancement in the treatment options available to patients with peripheral arterial disease. The minimally invasive nature of the procedure allows for outpatient treatment in many cases, reducing healthcare costs and improving patient satisfaction.

Future Directions

Based on these promising initial results, we plan to expand our endovascular program to include more complex lesions and explore the use of adjuvant technologies such as atherectomy devices and vascular stents. Continued follow-up of our patients will provide valuable data on long-term patency and clinical outcomes.

Conclusion

Balloon angioplasty of iliac and femoro-popliteal arteries can be performed safely and effectively with appropriate training and patient selection. This technique offers a valuable less-invasive alternative to traditional surgical reconstruction for carefully selected patients with peripheral arterial disease.

The successful implementation of this technology at Al-Zhraa University Hospital marks an important milestone in the development of endovascular surgery in Egypt and provides a foundation for future advances in minimally invasive vascular interventions.