Combined percutaneous transluminal angioplasty, iliac stent deployment, and femorofemoral bypass for bilateral aortoiliac occlusive disease.
BACKGROUND
We examine the technique of combining percutaneous transluminal angioplasty and secondary intravascular stent deployment with femorofemoral bypass graft in patients with bilateral aortoiliac occlusive disease.


METHODS
Retrospective review.


RESULTS
During the 5-year period from June 1988 to October 1993, 18 patients with iliac occlusion and a hemodynamically significant contralateral iliac stenosis were treated using a combination of endovascular and open surgical techniques. Patients (13 men and 5 women) ranged in age from 50 to 78 years (mean, 64 years). Thirteen patients (72 percent) were treated for claudication, and 5 patients (28 percent) for rest pain or ulceration. Residual intra-arterial pressure gradients following percutaneous transluminal angioplasty or significant postpercutaneous transluminal angioplasty dissection were the indications for stent deployment in 15 and 3 patients, respectively. No operative deaths occurred, but 3 patients (16 percent) had early complications. Primary patency, as determined by life table analysis, was 100 percent, 79 percent, 62 percent, and 51 percent at 1, 2, 3, and 5 years, respectively. Secondary patency at 1, 2, 3, and 5 years was 100 percent, 93 percent, 75 percent, and 63 percent, respectively, with a mean follow-up of 41 months.


CONCLUSIONS
The combination of percutaneous transluminal angioplasty with primary or secondary stent deployment and femorofemoral bypass can be a useful option for treating iliac occlusion and contralateral iliac stenosis of less than 3 cm in length when the severity of the comorbid illnesses, advanced age, or the presence of prohibitive intra-abdominal pathology makes the avoidance of an abdominal incision desirable.
Lopez-Galarza
L A
LA
Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix 85006, USA.
Ray
L I
LI
Rodriguez-Lopez
J
J
Diethrich
E B
EB
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001018:Aortic Diseases / Q000601:surgery*; D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D015897:Comorbidity; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents