[Individual revascularization for treatment of multilevel arterial occlusive disease of lower extremity].
OBJECTIVE
To determine the clinical effect of sequence and cross bypass or combined with endovascular procedure for mutilevel arterial occlusive disease of lower extremity so as to investigate the credible treatment for mutilevel arterial occlusive disease of lower extremity.


METHODS
Between April 2004 and July 2005, 11 patients (14 limbs)underwent sequence and cross bypass, thromboendarterectomy or combined with endovascular procedure. Among of them, 10 cases were male and 1 case was female, aging 62-79 years(mean 70. 5 years), and including 8 cases of intermittent claudications (Fontaine stage II), 3 cases of rest pain (Fontaine stage III) and 1 case of toe ulcer with gangrene (Fontaine stage IV). Colour Doppler ultrasonography showed that 14 lower limbs were diagnosed as having multilevel arterial occlusive disease and the preoperation and ankle brachial index (ABI) was 0.36 +/- 0. 11 . Lower limb digital subtraction angiography (DSA) showed 3 cases of bilateral iliac artery stenosis, extrailiac artery occlusion and bilateral superficial femoral artery occlusions, 1 case of right common iliac artery stenosis, extrailiac artery occlusion and bilateral superficial femoral artery occlusions and 8 cases of unilateral extrailiac artery stenosis and superficial femoral artery occlusions. Postoperation tests of DSA,colour Doppler ultrasonography and ABI were done to observe cumulative patency rate after operation.


RESULTS
The follow-up period was from 3 to 26 months (mean 14.5 months ). All patients survived. The symptoms of intermittent claudication and rest pain disappeard in all patients. ABI was improved by 0.89 +/- 0.13 after procedure (P < 0.01). The overall salvage rate of limb was 100%. DSA was performed from 3 to 280 days after operation, the overall primary graft patency rate was 92.86% (13/14).


CONCLUSIONS
Sequence and cross bypass, thromboendarterectomy or combined with endovascular procedure in treatment of mutilevel occlusive disease of lower extremity was effective, less invasive and safe.
Zhang
Xiansheng
X
Department of Vascular Surgery, the First Hospital of Peking University, Beijing, 100034, PR China. zxs66229@sina.com
Guo
Hongjie
H
Wang
Weiliang
W
D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods