Multilevel Arterial Disease Research Articles

Combined Iliac Angioplasty and Infrainguinal Revascularization Surgery Are Effective in Diabetic Patients with Multilevel Arterial Disease

The success of percutaneous transluminal angioplasty (PTA) in the treatment of common and external iliac atherosclerotic lesions has been established for the general population. However, several studies have suggested that the presence of diabetes may reduce the effectiveness of iliac angioplasty, particularly in the setting of limb-threatening ischemia requiring concomitant lower extremity revascularization. This study compared the results of iliac artery PTA performed in conjunction with infrainguinal bypass for limb-threatening ischemia for diabetic (DM) and nondiabetic (non-DM) patients. Between 1991 and 2000, 159 PTA were performed in 126 patients (DM = 99/79%, non-DM = 27/21%) in conjunction with subsequent infrainguinal bypass for limb-threatening ischemia (gangrene = 42%, ulcer = 36%, rest pain = 22%). These patients were followed prospectively using a computerized vascular registry. Stents were placed in 34 (21.4%) cases for suboptimal angioplasty results. In this study the combined use of standard surgical and endoluminal modalities for the treatment of multilevel arterial occlusive disease resulted in excellent cumulative patency and limb salvage rates. The presence of diabetes did not alter these favorable results. Multimodal vascular therapy may be used effectively in diabetic patients with limb-threatening ischemia due to multiple levels of arterial occlusion.

Combined iliac angioplasty and infrainguinal revascularization surgery are effective in diabetic patients with multilevel arterial disease

Combined iliac angioplasty and infrainguinal revascularization surgery are effective in diabetic patients with multilevel arterial disease

Combined semiclosed iliac endarterectomy and distal arterial reconstruction for multilevel arterial disease

Semiclosed iliac endarterectomy in combination with an infrainguinal vascular reconstruction has been used over the past decade in the treatment of lower-limb ischaemia. Although the early results of this combination of operations were known, the durability of the external iliac endarterectomy had not been assessed and so an effort was made to review all surviving patients by duplex scanning. Between 1985 and 1993, 48 patients (51 limbs) underwent combined semiclosed iliac endarterectomy and infrainguinal vascular reconstruction for iliac and femoropopliteal occlusive disease. Some 49% of operations were performed for limb salvage. An iliofemoral bypass graft was required twice because of failure of the endarterectomy. A variety of distal arterial reconstructions was employed. One patient required a major amputation and there were two deaths. Mean (s.d.) ankle/brachial indices (ABI) rose from 0.54 (0.14) to 0.85 (0.25) after surgery. Some 85% of the patients who underwent operation for claudication became symptom free; 83% of patients who underwent operation for limb-threatening ischaemia became symptom free or improved to mild claudication during an average of 29 months follow-up. During the follow-up period five patients underwent a further procedure because of restenoses of the external iliac artery. A duplex scanning study was performed in 22 of the 51 limbs an average of 36 months after surgery. External iliac artery stenotic lesions were found in the area of the endarterectomy in three patients. Endarterectomy of the external iliac artery from the groin is an alternative for some patients with iliac arterial disease. In a patient scheduled for an infrainguinal bypass, when an unexpectedly greater degree of athermoma is found at operation in the common femoral and external iliac arteries, this operation may be performed. The durability of the operation as assessed by follow-up duplex scan is quite acceptable.

Combined Semiclosed Iliac Endarterectomy and Distal Arterial Reconstruction for Multilevel Arterial Disease

Semiclosed iliac endarterectomy in combination with an infrainguinal vascular reconstruction has been used over the past decade in the treatment of lower-limb ischaemia. Although the early results of this combination of operations were known, the durability of the external iliac endarterectomy had not been assessed and so an effort was made to review all surviving patients by duplex scanning. Between 1985 and 1993, 48 patients (51 limbs) underwent combined semiclosed iliac endarterectomy and infrainguinal vascular reconstruction for iliac and femoropopliteal occlusive disease. Some 49% of operations were performed for limb salvage. An iliofemoral bypass graft was required twice because of failure of the endarterectomy. A variety of distal arterial reconstructions was employed. One patient required a major amputation and there were two deaths. Mean (s.d.) ankle/brachial indices (ABI) rose from 0.54 (0.14) to 0.85 (0.25) after surgery. Some 85% of the patients who underwent operation for claudication became symptom free; 83% of patients who underwent operation for limb-threatening ischaemia became symptom free or improved to mild claudication during an average of 29 months follow-up. During the follow-up period five patients underwent a further procedure because of restenoses of the external iliac artery. A duplex scanning study was performed in 22 of the 51 limbs an average of 36 months after surgery. External iliac artery stenotic lesions were found in the area of the endarterectomy in three patients. Endarterectomy of the external iliac artery from the groin is an alternative for some patients with iliac arterial disease. In a patient scheduled for an infrainguinal bypass, when an unexpectedly greater degree of athermoma is found at operation in the common femoral and external iliac arteries, this operation may be performed. The durability of the operation as assessed by follow-up duplex scan is quite acceptable. Copyright © 1996 Published by Elsevier Science Ltd.

Effect of distal occlusions on the assessment of aorto-iliac pathology by analysis of doppler spectra

In patients with multilevel arterial obstructive disease, assessment of the severity and location of the pathology is a difficult diagnostic problem. As reported recently, the intra-arterial pressure in the common femoral artery may become normal, although aorto-iliac obstructive disease is present if the superficial femoral artery is occluded. Aorto-iliac obstructive disease can also be assessed by analysis of Doppler spectra obtained from the common femoral artery. In this study, we evaluate if this assessment of aorto-iliac obstructive disease is also harmfully affected by an occlusion in the superficial femoral artery. The results of this study demonstrate that some Doppler parameters (such as acceleration time, slope of the acceleration phase, and the resistance index), which are essential for the assessment of aorto-iliac obstructive disease, are not significantly affected by an occlusion in the superficial femoral artery. Moreover, the study shows that the status of the superficial femoral artery may also be assessed by analysis of Doppler spectra obtained from the common femoral artery.

Obturator Bypass: a Sixteen Year Experience with 55 Cases

Fifty-five obturator bypasses were performed over a 16 year period for limb salvage. The indications for the choice of this technique included arterial infection, aneurysm formation or soft tissue skin loss at the groin (26 patients), and extensive atherosclerotic disease of the iliofemoral vessels, precluding their use for inflow or outflow (27 patients). There were five perioperative deaths and the five-year patency rate was 37%. Long-term results after above-knee reconstruction substantially exceeded those for below-knee anastomoses (three year patency rates of 71% and 45% respectively). Due to its morbidity and mortality the decision to perform an obturator bypass should be based upon sound indications such as deep infection at the groin, or extensive multilevel arterial disease. Its usefulness in extensive multilevel arterial disease is not demonstrated.