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[Isolated proximal revascularization for double aorto-iliac and femoral lesions]
F Bacourt1, B Lenot, O Goeau-Brissonnière
1Hôpital Américain, Neuilly.
Insights
Upper-level revascularization effectively treats claudication and critical limb ischemia. Secondary downstream procedures are reserved for cases where initial treatment is insufficient, particularly with extensive deep femoral artery disease.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Outcomes
Context:
- Aortoiliac and femoral obstructive lesions often require complex revascularization strategies.
- Evaluating the efficacy of upper-level revascularization versus combined upper and lower-level approaches is crucial.
Purpose:
- To assess the outcomes of upper-level revascularization in patients with aortoiliac and femoral obstructive lesions.
- To determine the necessity and effectiveness of secondary downstream revascularization.
Summary:
- Aortofemoral revascularization resolved symptoms in 94% of claudication cases and 80% of critical ischemia cases.
- Upper revascularization alone was sufficient for most patients, with secondary procedures needed in only 4% of critical ischemia cases.
- Extensive deep femoral artery involvement necessitates simultaneous upper and lower-level revascularization.
Impact:
- Upper-level revascularization is a justifiable primary approach, with clinical outcomes guiding decisions for secondary downstream extension.
- This strategy optimizes treatment for peripheral artery disease, potentially reducing unnecessary interventions.
- The findings support tailored surgical management based on disease extent and patient presentation.
Abstract:
From 1980 to 1990, 101 limbs were revascularized at the upper level only in 67 patients, while they presented with associated aortoiliac and femoral obstructive lesions. The symptoms disappeared after aortofemoral revascularization in 94% of the limbs operated on for claudication and 80% of those operated on for critic ischemia. Surgery of the deep femoral artery was associated in 51% of all cases. The average time lapse is 58 months. No complementary revascularization was needed in the cases of claudication. Out of the patients operated on for critic ischemia, upper revascularization was insufficient in 8 cases. Two of the operated patients were cured after secondary downstream revascularization (4%). Three operated patients still presented with intermittent claudication (6%), and 3 were amputed due to acute iliac obstruction seen at an advanced stage. As no reliable predictive test is available, we find it justified to carry out only upper revascularisation in most cases and to decide on the need for secondary downstream extension according to the clinical outcome. However, simultaneous revascularization at both levels is required in case of extensive involvement of the deep femoral artery, such as observed in only 5 of the patients operated during the same period.