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Iliac angioplasty as a prelude to distal arterial bypass
Insights
Iliac angioplasty before distal bypass is a successful strategy for multilevel arterial disease, offering good graft patency and limb salvage rates. This approach helps manage complex limb ischemia cases effectively.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Limb ischemia with diffuse aortoiliac or femoropopliteal disease poses surgical challenges.
- Multilevel arterial occlusive disease requires effective treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of iliac angioplasty as a prelude to distal bypass surgery.
- To assess outcomes in patients with multilevel arterial occlusive disease.
Main Methods:
- Retrospective review of iliac angioplasty cases preceding distal arterial bypass.
- Kaplan-Meier life table analysis and log-rank comparison for outcome assessment.
Main Results:
- 81% primary graft patency at five years; 76% overall iliac angioplasty success.
- 78% limb salvage in patients with threatened extremities; no perioperative mortality.
- 37 patients underwent angioplasty followed by various distal reconstructions.
Conclusions:
- Iliac angioplasty is a viable prelude to distal arterial bypass in multilevel disease.
- Low angioplasty failure rates and potential for salvage through operation or repeat dilatation.
- Close follow-up is crucial for managing inflow hemodynamics and preventing graft closure.
Background:
Patients with limb ischemia and diffuse aortoiliac or combined aortoiliac and femoropopliteal disease present as a difficult problem for surgeons. This study was done to determine whether or not angioplasty can be successfully used as a prelude to distal bypass in patients with multilevel arterial occlusive disease.
Study Design:
This is a retrospective review of an entire hospital experience with iliac angioplasty used as a prelude to distal arterial bypass. Kaplan-Meier life table analysis was performed and comparisons were made using log rank method.
Results:
During a six year period, 37 patients underwent percutaneous iliac angioplasty before distal arterial reconstruction. Subsequent arterial reconstructions included femorofemoral bypass in nine patients, femoropopliteal bypass in 25 patients, femorotibial bypass in two patients, and common femoral endarterectomy in the remaining patient. The primary graft patency rate was 81 percent at five years. The overall success of iliac angioplasty was 76 percent at five years. Limb salvage was achieved in 78 percent of the patients with threatened extremities, and there was no perioperative mortality.
Conclusions:
Iliac angioplasty can successfully be used as a prelude to distal arterial bypass in patients with multilevel disease. The rate of angioplasty failure is low and grafts often remain patent in the face of early hemodynamic inflow failure, allowing salvage by operation or repeat dilatation. Close follow-up evaluation will allow early detection and appropriate correction of changes in inflow hemodynamics that occur before graft closure.