When non-invasive angiography has identified the areas of occlusive disease, then angioplasty can be carried out as an invasive procedure. Angioplasty is indicated in the treatment of single or multiple stenoses or short segment occlusions of less than 10 cm. The aim is to improve the arterial circulation, achieve straight-line flow to the foot and bring about an increased blood supply to the site of ulceration and infection (Fig. 5.26a-c). Although the foot pulses may not be restored, there is usually a notable increase in the transcutaneous oxygen tension.

Angioplasty can be performed in two ways: conventional transluminal angioplasty using balloon catheters inserted through the true arterial lumen and more recently subintimal angioplasty with the catheters inserted into the subintimal plane.

Angiography and angioplasty are safe procedures with few complications so long as appropriate precautions are taken. Investigations should include:

• A recent full blood count, including a platelet count

• Blood coagulation indices

• Serum electrolytes and creatinine

The patient should not be dehydrated. Start an insulin sliding scale together with intravenous fluids before the procedure. Dopamine is no longer used to protect kidney function but it is important to keep the patient hydrated with intravenous fluids prior to the procedure. Patients with impaired renal function should be prescribed acetyl cysteine 600 mg bd 24 h before the procedure and on the day of the procedure.

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