Peripheral Vascular Surgery Society

Purpose: To review our recent experience with the combined use of iliac artery angioplasty and infrainguinal surgical revascularization for the treatment of multilevel atherosclerotic disease.

Methods: A retrospective review of all patients with multilevel atherosclerotic disease who were treated with both iliac artery angioplasty and infrainguinal bypass surgery during a 4 year period was performed. The medical records and preoperative arteriograms of all patients were reviewed for demographic information, radiologic findings, and postoperative follow-up data.

Results: Ninety-five limbs in 89 patients were studied. There were 58 male and 31 female patients with an average age of 67.2 years (range: 38-90). Indications for treatment included intermittent claudication (36%), ischemic rest pain (22.1%), and ulceration/tissue loss (41.9%). One hundred-fifteen iliac artery stenoses were dilated with hemodynamic and/or angiographic improvement seen in 89%. Seven percent of patients had a residual stenosis >50% after angioplasty; these patients were further treated with intraarterial stent placement or aortoiliac surgery. Infrainguinal reconstruction was performed in 24.2% with PTFE, 53.7% with an in situ saphenous vein graft, and 20% with an excised vein graft. A femoral endarterectomy was performed in 7.4% of patients. Secondary procedures were required to maintain limb salvage in 12.6%. Life-table analysis revealed 48 month primary patency rates for PTFE grafts, in situ saphenous vein grafts, and excised vein grafts to be 63.8%, 77.8%, and 73.7%, respectively, while secondary patency rates were 67.9%, 85.6% and 70%, respectively.

Conclusion: The combined use of iliac artery angioplasty and infrainguinal surgical revascularization is an effective and durable means of treating multilevel atherosclerotic disease.