On-table endovascular intervention combined with infrainguinal bypass surgery—A district general hospital experience

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To evaluate our practice of simultaneous on-table iliac angioplasty or stenting with infrainguinal bypass surgery in selected group of patients, we reviewed all patients who underwent on-table endovascular procedure combined with infrainguinal bypass surgery between 1995 and 1999. The procedures were performed in the absence of a radiologist. During the study period, 52 patients (mean age 64) underwent a combined procedure for disabling claudication, rest pain or ulceration. All patients were found to have multisegment disease on initial arteriogram with 65% having good distal run off. Patients underwent an endovascular procedure (63% on-table iliac angioplasty and 37% on-table iliac stenting) combined with femoro-popliteal bypass (52%), femoro-femoral crossover graft (36%), femoral endarterectomy (10%) and femoro-distal bypass (2%). Two thirds of patients had improvement in symptoms and ankle brachial pressure index during the early follow-up period (6 weeks). At the time of performing the audit, 7 patients (13%) have required further operations for limb salvage, and 3 patients (6%) underwent amputation. Patients with multilevel vascular disease may require multiple admissions for iliac stenting or angioplasty followed by distal vascular reconstruction. Vascular surgeons performing a combined procedure under one general anaesthetic can reduce the number of hospital admissions and interventions.