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Combined transluminal angioplasty and infrainguinal reconstruction in multilevel atherosclerotic disease
G A Peterkin1, M Belkin, N L Cantelmo
1Division of Surgery, Boston University Medical School, Massachusetts.
Insights
This study shows that combining iliac angioplasty with infrainguinal bypass surgery effectively treats severe multilevel atherosclerotic disease, improving limb salvage rates and patient outcomes.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Multilevel atherosclerotic disease poses significant surgical challenges.
- Patients often present with multiple comorbidities, including coronary artery disease, hypertension, and diabetes.
- Smoking is highly prevalent in this patient population.
Purpose of the Study:
- To evaluate the safety and efficacy of combined iliac transluminal angioplasty and infrainguinal reconstruction.
- To assess outcomes in patients with severe multilevel atherosclerotic disease.
Main Methods:
- Retrospective review of 46 patients undergoing combined iliac angioplasty and infrainguinal reconstruction.
- Procedures included angioplasty with distal bypass or femoral endarterectomy.
- Outcomes were assessed via vascular laboratory studies and life-table analysis.
Main Results:
- Significant reduction in iliac artery pressure gradients post-angioplasty.
- Improved mean ankle-brachial index (ABI) from 0.35 to 0.71 (p < 0.05).
- Achieved a 72% 5-year primary patency rate and 93% 5-year limb salvage rate.
Conclusions:
- Combined iliac angioplasty and infrainguinal reconstruction is a safe and effective treatment strategy.
- This approach offers a viable solution for managing complex cases of severe multilevel atherosclerotic disease.
- The procedure demonstrates favorable long-term limb salvage and patency rates.
Abstract:
Patients with multilevel atherosclerotic disease represent a difficult surgical challenge. This report is a retrospective review of 46 patients who were treated using a combination of iliac transluminal angioplasty and infrainguinal reconstruction. There were 42 male and 4 female patients with an average age of 62 years (range: 40 to 74 years). Follow-up ranged from 1 month to 10 years (mean: 27.3 months). These patients had multiple health problems typical of patients with peripheral vascular disease, including coronary artery disease (67%), hypertension (61%), and diabetes mellitus (42%); 80% of the patients were smokers. Forty-one patients were treated for rest pain and/or tissue loss, while five were treated for incapacitating claudication. Forty-three patients had a combination of angioplasty and distal bypass, while 3 patients had a form of femoral endarterectomy. Iliac artery pressure gradients were reduced from 35.4 +/- 4 mm Hg preangioplasty to 0.6 +/- 0.3 mm Hg postangioplasty. The procedures were well tolerated with no mortality and four serious complications. Vascular laboratory studies showed an improvement in the mean ankle-brachial index from 0.35 +/- 0.03 preoperatively to 0.71 +/- 0.04 postoperatively (p less than 0.05). Life-table analysis revealed a 72% 5-year primary patency rate, with a 93% 5-year limb salvage. Eight patients required a secondary procedure to maintain limb salvage. Five patients underwent amputation, three due to early graft thrombosis and two due to late graft failure. We conclude that combined iliac angioplasty and infrainguinal reconstruction is a safe and effective method for managing the patient with severe multilevel atherosclerotic disease.