Intraoperative Endovascular Angioplasty and Stenting of Iliac Artery: An Adjunct to Femoro–Popliteal Bypass

Abstract

Background: With the rapid development of endovascular techniques, the management strategy of patients with multilevel atherosclerotic arterial occlusive disease is also evolving. Iliac artery stenting is a means whereby multiple bypass operations can be avoided in such patients. The early results of preoperative iliac artery stenting seem promising but the role of intraoperative iliac artery angioplasty and stenting is less clear. Study Design: This study was undertaken to evaluate our early results of a combined endovascular and operative approach to patients with multilevel atherosclerotic arterial occlusive disease. Between June 1995 and March 1997, primary intraoperative iliac artery balloon angioplasty and stent placement were performed on 13 affected limbs of 12 patients undergoing an infra-inguinal bypass operation. Indications for operation, patient demographics, and risk factors were noted. The outcome of surgery and the patency rates of bypass graft and stent were also recorded. Results: The initial technical success of primary iliac artery angioplasty and stenting was 93%. An improvement of the ankle-brachial index by a mean value of 0.38 was attained after operation (p < 0.001). Clinical success, based on the criteria suggested by the Society for Vascular Surgery/International Society for Cardiovascular Surgery, was achieved in all patients. There was no operative or hospital mortality. Postoperative morbidity rate was 8% (n = 1). The cumulative 1-year patency rates of iliac stent and infra-inguinal bypass grafts were 100% and 85%, respectively. The limb loss rate was 7%. Conclusions: The technique of intraoperative angioplasty and stenting can be easily mastered by an experienced and skilled vascular surgeon, using a portable C-arm fluoroscopic unit, in the operation theater. A combined endovascular and operative approach optimizes the therapeutic option to this selected group of patients.