title: A comparison of operative approaches and parameters predictive of success in multilevel arterial occlusive disease.
abstract: BACKGROUND
  The correction of abnormal inflow alone in patients with multilevel arterial occlusive disease (MLAOD) may be inadequate to relieve limb-threatening ischemia. This study was undertaken to compare operative approaches and attempt to define preoperative parameters predictive of limb salvage in patients with MLAOD.
  
  
  METHODS
  The outcome after revascularization for 194 patients with limb-threatening ischemia MLAOD was assessed retrospectively. One hundred fifty-one patients initially underwent an inflow operation alone. Based on whether or not these patients required an outflow operation within one year, they were divided into two groups: group 1, no outflow operation (121 patients, 121 limbs), and group 2, outflow operation required for continued ischemic symptoms (30 patients, 30 limbs). A separate group of forty-three patients (43 limbs) underwent synchronous inflow-outflow operations, or multilevel revascularization, as their initial operative procedure (group 3).
  
  
  RESULTS
  Perioperative complications and mortality rates did not differ between groups. Limb salvage rates were similar for groups 1 and 3, whereas in group 2, limb salvage rates were significantly reduced (p = 0.0184). Long-term limb salvage after an isolated inflow procedure was associated with lack of prior vascular reconstructions (p = 0.0002), the absence of tissue loss (p = 0.0019), and an infrageniculate angiographic runoff score of less than 6 (p = 0.054).
  
  
  CONCLUSIONS
  In patients with limb-threatening MLAOD, synchronous inflow-outflow operations can be performed with resultant morbidity and mortality rates comparable with inflow alone. After an inflow operation, the approach of "expectant management" may ultimately compromise limb salvage if a subsequent outflow operation is required.
authors.affiliation: Division of Vascular Surgery, University of Illinois College of Medicine at Chicago.
authors.forename: T J
authors.initials: TJ
authors.lastname: Nypaver
authors.forename: M I
authors.initials: MI
authors.lastname: Ellenby
authors.forename: O
authors.initials: O
authors.lastname: Mendoza
authors.forename: J P
authors.initials: JP
authors.lastname: Meyer
authors.forename: T H
authors.initials: TH
authors.lastname: Schwarcz
authors.forename: H
authors.initials: H
authors.lastname: Baraniewski
authors.forename: J J
authors.initials: JJ
authors.lastname: Schuler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D013223:Statistics as Topic; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods