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Proximal percutaneous balloon angioplasty and distal bypass for multilevel arterial occlusion. Veterans
S E Wilson1, G H White, G Wolf
1Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509.
Insights
This study shows that combining iliac angioplasty with distal bypass surgery is an effective treatment for high-risk patients with multilevel atherosclerotic occlusion. The procedure significantly improved ankle brachial index and offered a 76% success rate at two years.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Multilevel atherosclerotic occlusion poses treatment challenges in high-risk patients.
- Current treatment options may involve complex surgical reconstructions.
Purpose of the Study:
- To evaluate the efficacy of combining proximal iliac angioplasty with distal bypass for multilevel lower extremity occlusive disease.
- To assess the outcomes and success rates of this combined approach in high-risk patients.
Main Methods:
- A cohort of 18 male patients with symptomatic peripheral vascular disease underwent proximal iliac percutaneous transluminal angioplasty combined with various distal bypass procedures.
- Pre- and post-procedure ankle brachial index (ABI) was measured.
- Follow-up included clinical assessment and life table analysis for procedural success and complications.
Main Results:
- No operative deaths occurred.
- The mean ABI significantly improved from 0.40 to 0.64 by discharge and was maintained at 27 months (0.65).
- The two-year success rate for the combined procedures was 76%, with complications including one re-intervention and two late amputations.
Conclusions:
- Combined proximal iliac angioplasty and distal bypass is an acceptable and effective alternative for multilevel arterial occlusions in selected high-risk patients.
- This approach offers significant hemodynamic improvement and a reasonable success rate in managing complex peripheral artery disease.
Abstract:
Multiple sites of atherosclerotic occlusion in high risk patients may be treated by angioplasty of the iliac obstruction and distal reconstruction. We report 18 male patients with symptomatic peripheral vascular disease in whom proximal iliac percutaneous transluminal angioplasty was combined with femoropopliteal bypass (11), femorotibial bypass (2), or femorofemoral bypass (5). There were no operative deaths. The pretreatment ankle brachial index of 0.40 +/- 0.04 was increased to 0.64 +/- 0.04 by discharge (p = 0.0001), and remained significantly increased through 27 months (0.65 +/- 0.07) (p = 0.0001). During the follow-up period of 2-57 (mean 27 months) one dilated iliac artery required repeated percutaneous transluminal angioplasty and revision of the femoropopliteal bypass at three months. Two late amputations of study limbs occurred at two years and three years due to progression of distal disease in the infrapopliteal segment. Four patients died during the follow-up period of ischemic heart disease (3) and lung carcinoma (1). Life table analysis shows a 76% success rate for the combined procedures at two years. In selected, high risk patients, proximal iliac dilatation and distal bypass is an acceptable alternative reconstruction for multilevel occlusion.