Long-term effects of combined iliac dilatation and distal arterial surgery.
OBJECTIVE
When standard aortofemoral surgical procedure is combined with lower extremity vascular surgery, problems related with the hospital stay, morbidity, mortality and the cost of treatment will exist. The number of reports relating to combined iliac artery PTA and distal bypass surgery is limited. After the development of stenting procedures, the results of arterial system plasty have much more improved. This report reviews our preliminary experience with iliac artery angioplasty with distal bypass procedures.


METHODS
A total of 41 patients have undergone combined iliac artery dilatation and distal arterial revascularization. Angioplastic procedures were performed in the angiography suite and distal surgery was carried out at the same day or the day after. Of all patients, 29 underwent percutaneous transluminal angioplasty (PTA) and 12 underwent combined PTA and stent placement. Ipsilateral femoropopliteal bypass was performed as a distal revascularization procedure in all patients.


RESULTS
Mean systolic iliac artery pressure gradients improved from 34.7+/-8.6 mmHg to 3.9+/-3.2 mmHg after angioplastic procedures (P < 0.0001). Six patients needed reangioplasty because of restenosis in the follow-up period. Thrombectomy was performed on 1 patient in the early postoperative period and re-do femoropopliteal bypass was performed on two patients in the 2nd and 23rd months. Three minor wound infections were successfully treated with antibiotics and local care. Mean follow-up was 21.4 months (range 1-48 months). By life-table analyses, the overall 4-year cumulative primary patency of combined procedures was 78.1%.


CONCLUSIONS
The results show that the combined procedure is a suitable method for the treatment of patients with multiple stenotic lesions at the iliac and distal arterial levels. We believe that the combined use of PTA and distal vascular surgery by an experienced surgical team will give beneficial results and a highly satisfactory outcome in this group of patients.
Sinci
V
V
Department of Thoracic & Cardiovascular Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
Kalaycioğlu
S
S
Halit
V
V
Gökgöz
L
L
Soncul
H
H
Ilgit
E
E
Oktar
L
L
Ersöz
A
A
D017130:Angioplasty; D000800:Angioplasty, Balloon; D001161:Arteriosclerosis / Q000601:surgery; D004106:Dilatation; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures