Iliac transluminal angioplasty and distal surgical revascularisation can be performed in a one-step technique

A few authors have suggested treating double-level atherosclerotic lesions in high risk patients by an association of iliac transluminal angioplasty (ITA) and distal surgical restoration in a two-step technique with an interval of one to three weeks between the two procedures. Previous reports of ITA showed the influence of the quality of the outflow on early results, we therefore decided to perform the two procedures mentioned above during the same operation.

During a five-year period, 51 patients (42 men, 9 women) underwent an isolated ITA in 32 cases (group I) or associated with a simultaneous surgical reconstruction (group II) in 19 cases. Mean age (56.4+/-12 years versus 63.9+/-11.8 years, p<0.01), frequency of limb-threatened ischaemia (2.6% versus 42.1% p<0.001), and of an ipsilateral thrombosed or severely stenotic femoral artery (20% versus 100%, p<0.001) were significantly higher in group II. In group I (n=32), 45 unique or double iliac lesions (unilateral=25, bilateral=7) including 42 stenosis (>75%) and three thrombosis were treated. In group II (n=19), ITA was performed on unique and unilateral iliac stenosis (>75%) in association with a femoro-femoral bypass (n=4), an ipsilateral femoro-popliteal bypass (n=5) or femoro-tibial bypass (n=3) or an ipsilateral deep or common femoral reconstruction (n=7).

Early complications consisted of one haematoma (group I), one death and one iliac restenosis (group 2). After a mean follow-up of 20 months, cumulative patency of groups I and II was respectively 81% and 88% (p=ns), with an increase in the ankle/brachial systolic pressure ratio from 0.73+/-0.14 to 0.92+/-0.14 (p<0.001) in group I, and from 0.57+/-0.15 to 0.84+/-0.12 (p<0.001) in group II.

Early and mid-term results of the one-step technique are similar to those obtained with patients who underwent ITA with good initial outflow. This technique can therefore be recommended in high-risk patients with double-level atherosclerotic lesions including severe iliac stenosis.