Combined iliac artery angioplasty and infrainguinal reconstruction in multilevel atherosclerotic disease

ABSTRACT

Patients with limb ischemia and diffuse aortoiliac or combined aortoiliac and femoropopliteal disease present as a difficult problem for surgeons. Is to present our early experience with the combined use of iliac artery angioplasty and infrainguinal surgical revascularization for the treatment of multilevel artherosclerotic disease. Thirteen patients with iliac artery stenosis and femoropopliteal occlusive disease were treated with fem-pop grafting and iliac balloon angioplasty [IBA] which was performed percutaneously within 1-2 days before surgery. Stenting was performed for suboptimal IBA. Graft patency was evaluated by clinical examination, duplex scanning/ankle-brachial index [[ABI] at 1, 3, 6, and 12 months. indications for surgery were limb salvage [46%], rest pain [23%], and claudication [31%]. IBA alone was successful in 10 patients. Stenting was needed in the remaining 3 patients. Distal bypass grafting was performed with an autogenous vein conduit in 10 patients. PTFE placed in the above-knee popliteal segment was used in 3 patients. The primary patency of combined procedures at 1year was 81.8%. There was only one amputation with an overall limb salvage rate of 90.9%. Iliac angioplasy can successfully be used as a prelude to distal arterial bypass in patients with multilevel atherosclerotic disease