Endovascular treatment of infra-aortic atherosclerotic arterial disease

ABSTRACT

Endovascular therapy has an important and definitive role for patients with critical limb ischemia. It easily revascularizes inflow and outflow lesions with minimal morbidity and mortality. One hundred and thirteen patients with critical limb ischemia underwent endovascular procedures either alone or combined with surgical bypass [n=29] with no procedure-related mortality. All patients had angioplasty while 8 of 12 patients with aortic bifurcation disease, 22 of 28 with iliac disease, and 28 of 44 with femoropopliteal disease had stent placement as well. Initial success rates were 100% for the aortic bifurcation group, 96.3% for the iliac group, and 90.7% for the femoropopliteal group. Two-year patency rates were 83.3% for the aortic bifurcation group, 85.2% for the iliac group, and 72.1% for the femoropopliteal group. Twenty nine patients underwent simultaneous iliac endovascular and infrainguinal bypass procedures. This group included 21 angioplasty of the common iliac artery with stent placement in 16 patients and 8 angioplasties of the external iliac artery with stent placement in 4. Pemoropopliteal bypass was performed in 18 patients using vein grafts in 14 patients and synthetic polytetrafluoroethylene grafts in 4 patients. Femorotibial bypass was performed in 11 patients using vein grafts. The initial success rate for this simultaneous endovascular and surgical bypass was 93.1% and the 2-year patency rate was 75.9%. Our results demonstrate that endovascular therapy is a low-risk procedure with satisfactory initial and 2-year success rates