Combined operative angiodilation and arterial reconstruction for limb salvage

Fifteen high-risk patients with threatened limb loss underwent combined operative iliac angiodilation and infrainguinal vascular reconstruction for iliac and femoropopliteal occlusive disease. The patients were poor candidates for combined surgical inflow and outflow reconstruction because of associated cardiopulmonary disease. The mean systolic pressure gradient across the iliac stenosis was 34 +/- 5 mm Hg. Iliac artery angiodilation was accomplished intraoperatively and reduced all gradients to zero. Stenoses in the distal portion of the deep femoral artery were endarterectomized in nine patients, and six cross-femoral and six distal popliteal or tibial grafts were constructed. Life-table analysis at 36 months showed iliac patency in 86% of cases and successful distal reconstruction in 76%. Our limb salvage rate of 86% suggests that combined intraoperative angiodilation by the angiographer and arterial reconstruction by the vascular surgeon may provide effective therapy for high-risk patients.