ILIAC ANGIOPLASTY AS A PRELUDE TO DISTAL ARTERIAL BYPASS

BACKGROUND: Patients with limb ischemia and diffuse aortoiliac or comb ined aortoiliac and femoropopliteal disease present as a difficult pro blem for surgeons. This study was done to determine whether or not ang ioplasty can be successfully used as a prelude to distal bypass in pat ients with multilevel arterial occlusive disease. STUDY DESIGN: This i s a retrospective review of an entire hospital experience with iliac a ngioplasty used as a prelude to distal arterial bypass. Kaplan-Meier l ife table analysis was performed and comparisons were made using log r ank method. RESULTS: During a six year period, 37 patients underwent p ercutaneous iliac angioplasty before distal arterial reconstruction. S ubsequent arterial reconstructions included femorofemoral bypass in ni ne patients, femoropopliteal bypass in 25 patients, femorotibial bypas s in two patients, and common femoral endarterectomy in the remaining patient. The primary graft patency rate was 81 percent at five years. The overall success of iliac angioplasty was 76 percent at five years. Limb salvage was achieved in 78 percent of the patients with threaten ed extremities, and there was no perioperative mortality. CONCLUSIONS: Iliac angioplasty can successfully be used as a prelude to distal art erial bypass in patients with multilevel disease. The rate of angiopla sty failure is low and grafts often remain patent in the face of early hemodynamic inflow failure, allowing salvage by operation or repeat d ilatation. Close follow-up evaluation will allow early detection and a ppropriate correction of changes in inflow hemodynamics that occur bef ore graft closure.