796-3 Treatment of Superficial Femoral Artery Occlusion by Percutaneous Revascularization of Ipsilateral Iliac Artery Stenosis

Abstract

The acute and long-term results of percutaneous revascularization of the lower extremities are typically superior for inflow (iliac) than distal (superficial femoral artery SFA, popliteal, or infrapopliteal disease). Accordingly, we investigated the utility of performing percutaneous revascularization for only inflow (iliac) lesions in pts with both inflow as well as distal disease. We treated 43 limbs in 36 pts (28 M, 8 F, age mean ± SD = 69 ± 8 yrs) with the combination of SFA occlusion and ipsilateral iliac artery lesions by percutaneous revascularization of the iliac artery lesion only. Ten lesions involved the common iliac artery, 18 involved both the common and the external iliac arteries, and 15 consisted of external iliac artery stenosis. All pts were symptomatically Rutherford class 3 and/or above. Mean ankle-brachial index (ABI) pre-procedure was 0.55 ± 0.19. Ipsilateral iliac artery stenosis, determined by quantitative angiography, was 80 ± 12%. All iliac lesions were treated with percutaneous transluminal angioplasty (PTA) ± stent placement. PostPTA, iliac artery stenosis decreased to 8 ± 8%. Of the 43 treated limbs, 40 (93%) were associated with improvement by at least one Rutherford class. One month post-procedure, mean ABI improved to 0.63 ± 0.19(p < 0.009). Complications were limited to 1 instance of arterial dissection which was successfully treated with a stent. Six-month follow-up was available on 24/43 limbs; 19/24 (79%) continued to show improved symptoms measured by Rutherford class. ABI's were remeasured at six months in 22 pts, and 18/22 (82%) showed improved ABI compared to baseline. Percutaneous revascularization limited to iliac artery stenosis in patients with ipsilateral superficial femoral artery occlusion, by augmenting arterial inflow via a patent profunda, is frequently sufficient to produce clinical improvement of disabling symptoms.