title: Early results of external iliac artery stenting combined with common femoral artery endarterectomy.
abstract: OBJECTIVE
  The endovascular approach to external iliac artery (EIA) disease extending into the common femoral artery (CFA) has been avoided because of problems with stent placement across the inguinal ligament. Surgical treatment for this disease distribution includes extensive endarterectomy or bypass procedures or both. We report our initial experience with a combined open and endovascular approach to these patients.
  
  
  METHODS
  We performed a retrospective analysis of all patients who underwent intraoperative EIA stenting after CFA endarterectomy/patch angioplasty between 1997 and 2000. Stents were positioned to end at the proximal endarterectomy endpoint, without crossing the inguinal ligament. Technical success, hemodynamic success, and clinical success were determined according to Society of Vascular Surgery/International Society of Cardiovascular Surgery criteria. Life-table analysis was performed for patency.
  
  
  RESULTS
  Thirty-four patients (mean age, 68 years; 23 male, 11 female) had combined endovascular and open treatment of iliofemoral occlusive disease. Indications were claudication in 41% and critical limb ischemia in 59%. Femoral reconstruction included endarterectomy with patch angioplasty in all patients. EIA stent deployment incorporated the stenotic iliac segment and the proximal endpoint of the endarterectomy in all patients. Four patients (12%) also needed common iliac angioplasty at the same time for proximal iliac disease, and 14 patients (41%) also needed distal revascularization for associated femoropopliteal or tibial disease. Technical success and hemodynamic success were achieved in 100% of patients. Clinical success was achieved in 97% of patients. The mean postoperative increase in ankle-brachial index in patients with inflow procedures only was 0.36 (range, 0.1 to 0.85). The overall complication rate was 15%. With a mean follow-up period of 13 months (range, 0.5 to 28 months), 1-year primary patency and primary-assisted patency rates were 84% and 97%, respectively. No perioperative mortality was seen.
  
  
  CONCLUSIONS
  EIA stenting as an adjunct to CFA endarterectomy/patch angioplasty allows for more localized surgery than conventional bypass. This approach also allows a better interface between the stent and endarterectomy than staged preoperative stenting. Technical success and early patency rates are excellent.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH 03756, USA.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Nelson
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Powell
authors.forename: Marc L
authors.initials: ML
authors.lastname: Schermerhorn
authors.forename: Mark F
authors.initials: MF
authors.lastname: Fillinger
authors.forename: Robert M
authors.initials: RM
authors.lastname: Zwolak
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Walsh
authors.forename: Jack L
authors.initials: JL
authors.lastname: Cronenwett
mesh_terms: D000368:Aged; D017130:Angioplasty; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D004691:Endarterectomy; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery; D007383:Intermittent Claudication / Q000628:therapy*; D007511:Ischemia / Q000628:therapy; D007866:Leg / Q000098:blood supply*; D015993:Life Tables; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014654:Vascular Patency