title: Use of revascularized artery as a recipient in microvascular reconstruction of the lower leg: An analysis of 62 consecutive free flap transfers.
abstract: BACKGROUND
  This study aimed to demonstrate the safety and reliability of combined preoperative angioplasty and free flap transfer in patients with peripheral arterial occlusive disease (PAOD) by analyzing the surgical outcomes.
  
  
  METHODS
  Between October 2011 and October 2015, patients who had undergone lower extremity angiography and subsequent free flap transfer were retrospectively reviewed. Data collected included demographics, perioperative data, and postoperative outcomes. The cases were divided into two groups: one group with microanastomosis performed on revascularized artery by balloon angioplasty and the other group performed on native artery. Multiple logistic regression model using propensity score and linear regression was computed to determine the association between preoperative angioplasty and the surgical outcomes.
  
  
  RESULTS
  A total of 62 lower limb reconstruction cases (19 angioplastied cases and 43 nonangioplastied cases) were included in the study. Complications occurred in 6 cases in the angioplastied group and in 11 cases in the control group. The overall limb salvage rate was 100% during the average follow-up of 29.5 months in the angioplastied group and 97.7% in the nonangioplastied control group during the average follow-up of 31.1 months. Preoperative angioplasty was not a significant predictor of increased complications and longer postoperative downtime in logistic and linear regression model, both in the weighted and unweighted model.
  
  
  CONCLUSIONS
  The combined approach of preoperative endovascular revascularization and free flap transfer for limb reconstruction in PAOD patients can be performed safely and effectively with acceptable morbidity.
authors.affiliation: Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Hyung Min
authors.initials: HM
authors.lastname: Hahn
authors.affiliation: Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Yeon Seong
authors.initials: YS
authors.lastname: Jeong
authors.affiliation: Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: You Sun
authors.initials: YS
authors.lastname: Hong
authors.affiliation: Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Je Hwan
authors.initials: JH
authors.lastname: Won
authors.affiliation: Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Lim
authors.affiliation: Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Jinoo
authors.initials: J
authors.lastname: Kim
authors.affiliation: Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Myong Chul
authors.initials: MC
authors.lastname: Park
authors.affiliation: Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Dong Ha
authors.initials: DH
authors.lastname: Park
authors.affiliation: Ajou University School of Medicine, Suwon, Republic of Korea. Electronic address: i00325@live.co.kr.
authors.forename: Il Jae
authors.initials: IJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D016022:Case-Control Studies; D000072226:Computed Tomography Angiography / Q000379:methods; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008866:Microsurgery / Q000379:methods; D055806:Microvessels / Q000601:surgery; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D015424:Reperfusion / Q000379:methods; D012189:Retrospective Studies; D066027:Transplant Recipients
keywords: Angioplasty; Free flap; Lower leg reconstruction; Microsurgery