title: Efficacy of iliac inflow repair in patients with concomitant iliac and superficial femoral artery occlusive disease.
abstract: BACKGROUND
  In multilevel arterial disease, whether complete revascularization or staged runoff repair should be performed remains controversial. The aim of this study was to evaluate the efficacy of iliac inflow repair and to identify clinical conditions that are associated with the need for runoff repair in concomitant iliac and superficial femoral artery (SFA) occlusive disease.
  
  
  METHODS
  Patients undergoing inflow repair for complicated flow-limiting iliac lesions with diffuse SFA disease between 2007 and 2013 were retrospectively reviewed. Patients with poor response to inflow repair underwent infrainguinal revascularization (IIR).
  
  
  RESULTS
  The 29 ischemic limbs examined in this study represent 26 different patients (22 males; mean age, 77 ± 8 years). Indications for inflow repair were Rutherford Classifications III (31%), IV (31%), V (31%), and VI (7%). Severity of the complicated SFA disease was either TASC (TransAtlantic Inter-Society Consensus) type C (14%) or type D (86%). Overall, freedom from IIR was 90% after 30 days and 83% after 1 year. Patients having claudication, rest pain, and shallow ischemic ulcers experienced the relief of symptoms, whereas patients with deep gangrene that needed minor amputation required IIR more frequently (p < 0.01). Anatomical risk factors for poor response to inflow repair were poor quality of the deep femoral artery (p < 0.01) and the flow-limiting popliteal artery (p = 0.02), and poor below-knee runoff (≤ 1 vessel, p < 0.01).
  
  
  CONCLUSIONS
  Iliac inflow repair can reverse the symptoms in patients with multilevel arterial occlusive disease that are not associated with gangrenous toes.
authors.affiliation: Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan. Electronic address: daijirou@med.tohoku.ac.jp.
authors.forename: Daijirou
authors.initials: D
authors.lastname: Akamatsu
authors.affiliation: Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Goto
authors.affiliation: Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kamei
authors.affiliation: Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan.
authors.forename: Shigehito
authors.initials: S
authors.lastname: Miyagi
authors.affiliation: Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Tsuchida
authors.affiliation: Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Kawamura
authors.affiliation: Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Tajima
authors.affiliation: Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan.
authors.forename: Michihisa
authors.initials: M
authors.lastname: Umetsu
authors.affiliation: Sendai City Hospital, Cardiovascular Surgery, 1-1 Nagamachi, Taihaku-ku Sendai, 982-8502, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku Sendai, 980-8574, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Ohuchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D000800:Angioplasty, Balloon / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D020127:Recovery of Function; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*
keywords: iliac artery; inflow repair; multilevel arterial disease; peripheral artery disease; superficial femoral artery