The Angiographic Change of Iliac Arteries after Bypass Surgery for the Atherosclerotic Occlusive Disease of Lower Extremity

ABSTRACT

PURPOSE: In the initiation and progression of the atherosclerosis many factors are related each other. The individual variations also complicate the prediction of the atherosclerotic process. The purpose of this study was to investigate the morphologic changes by angiography in iliac arterial segments of the patients who had received bypass operation for the infrainguinal atherosclerotic occlusive disease of the lower extremities. METHODS: Forty-five common iliac artery (CIAs) and forty-two external iliac arteries (EIAs) in twenty nine male patients who underwent angiography for graft failure of lower extremity bypass surgery was included in this retrospective study, and their clinical chart and angiographic findings of iliac arteries were reviewed. Acute arterial occlusive cases were excluded from this study. The mean interval from the previous bypass surgery was 38.9 months (from 6 to 96 months) and the patient ages ranged from 34 to 81 years (average age 59 years). It was considered as change, that is disease progression, when luminal narrowing of iliac artery was more than 25% compared to the previous angiography at bypass surgery. RESULTS: Of 45, fifteen CIAs (33.3%) showed change. In 3 patients, the change was bilateral; in 4, ipsilateral to the failed graft limb; and in 5, contralateral. Considering EIAs, 13 of 42 (31.0%) were changed. In 1 patient, the change was bilateral; in 6, ipsilateral to the failed graft limb; and in 5, contralateral. Therefore the side of the changed iliac arteries had no statistical significance in relation to the side of limb at which graft failure occurred (P<0.05). There was no significant correlation between age or interval between bypass operation and repeat angiography and the progression of atherosclerosis of iliac arteries. CONCLUSION: The progression of atherosclerosis is not dominated in iliac arteries ipsilateral to the side in which bypass surgery was performed and graft failure occurred. In iliac artery, the short-term progression of atherosclerosis observed by angiography may vary among individuals independently withage, interval between operation and repeat angiography, and the hemodynamic change of the infrainguinal arteries.