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Long-term effects of combined iliac dilatation and distal arterial surgery
V Sinci1, S Kalaycioğlu, V Halit
1Department of Thoracic & Cardiovascular Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
Insights
Combined iliac artery angioplasty with distal bypass surgery offers a suitable treatment for multiple arterial stenoses. This approach demonstrates beneficial outcomes and high patient satisfaction, improving iliac artery pressure gradients significantly.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Procedures
Background:
- Standard aortofemoral bypass combined with lower extremity vascular surgery presents challenges in hospital stay, morbidity, mortality, and cost.
- Limited reports exist on combined iliac artery percutaneous transluminal angioplasty (PTA) and distal bypass surgery.
- Arterial stenting has significantly improved the outcomes of arterial plasty procedures.
Purpose of the Study:
- To review the preliminary experience with combined iliac artery angioplasty and distal bypass procedures.
- To evaluate the efficacy and outcomes of this combined approach in treating complex iliac and distal arterial lesions.
Main Methods:
- A total of 41 patients underwent combined iliac artery dilatation and distal arterial revascularization.
- Procedures included percutaneous transluminal angioplasty (PTA) in 29 patients and PTA with stent placement in 12 patients.
- Ipsilateral femoropopliteal bypass was performed as the distal revascularization in all cases, with angioplasty and surgery performed concurrently or sequentially.
Main Results:
- Mean systolic iliac artery pressure gradients significantly improved from 34.7 mmHg to 3.9 mmHg post-procedure (P < 0.0001).
- The 4-year cumulative primary patency rate for the combined procedures was 78.1%.
- Complications included restenosis requiring reangioplasty in 6 patients, early thrombectomy in 1, and re-do bypass in 2; 3 minor wound infections occurred.
Conclusions:
- The combined iliac artery angioplasty and distal bypass procedure is a suitable and effective treatment for patients with multiple stenotic lesions.
- This combined approach, performed by an experienced team, yields beneficial results and high patient satisfaction.
- The study highlights the successful application of endovascular techniques alongside traditional bypass surgery for complex lower extremity arterial disease.
Purpose:
When standard aortofemoral surgical procedure is combined with lower extremity vascular surgery, problems related with the hospital stay, morbidity, mortality and the cost of treatment will exist. The number of reports relating to combined iliac artery PTA and distal bypass surgery is limited. After the development of stenting procedures, the results of arterial system plasty have much more improved. This report reviews our preliminary experience with iliac artery angioplasty with distal bypass procedures.
Patients And Methods:
A total of 41 patients have undergone combined iliac artery dilatation and distal arterial revascularization. Angioplastic procedures were performed in the angiography suite and distal surgery was carried out at the same day or the day after. Of all patients, 29 underwent percutaneous transluminal angioplasty (PTA) and 12 underwent combined PTA and stent placement. Ipsilateral femoropopliteal bypass was performed as a distal revascularization procedure in all patients.
Results:
Mean systolic iliac artery pressure gradients improved from 34.7+/-8.6 mmHg to 3.9+/-3.2 mmHg after angioplastic procedures (P < 0.0001). Six patients needed reangioplasty because of restenosis in the follow-up period. Thrombectomy was performed on 1 patient in the early postoperative period and re-do femoropopliteal bypass was performed on two patients in the 2nd and 23rd months. Three minor wound infections were successfully treated with antibiotics and local care. Mean follow-up was 21.4 months (range 1-48 months). By life-table analyses, the overall 4-year cumulative primary patency of combined procedures was 78.1%.
Conclusion:
The results show that the combined procedure is a suitable method for the treatment of patients with multiple stenotic lesions at the iliac and distal arterial levels. We believe that the combined use of PTA and distal vascular surgery by an experienced surgical team will give beneficial results and a highly satisfactory outcome in this group of patients.