COMBINED ILIAC TRANSLUMINAL ANGIOPLASTY AND FEMOROPOPLITEAL RECONSTRUCTION FOR MULTILEVEL ARTERIAL OCCLUSIVE DISEASE

Patients with multilevel arterial disease represent a challenging prob lem. A retrospective review of 46 consecutive femoropopliteal reconstr uctions combined with iliac balloon angioplasty was performed. Twenty- five procedures were below-knee and 21 to the above-knee popliteal art ery segment. Mean follow-up was 26.8 months (range 4 to 84). There wer e 2 peroperative deaths and 3 serious complications (10.9%). In the la te follow-up 4 significant restenoses and 1 reocclusion occurred for a patency rate of 81% for the inflow procedure at 5 years. Primary and secondary patency rate of combined procedures at 5 years was 61% and 7 6% respectively. The 5-year limb salvage rate was 93%. The mortality r ate, morbidity rate and cumulative patency were not significantly diff erent from a group of 38 patients who underwent 43 aortofemoral bypass es combined with femoropopliteal revascularization. In the latter grou p, the frequent incidence of anastomotic aneurysm (9.2%) was the main detrimental factor observed at follow-up. The authors conclude that fe moropopliteal reconstruction combined with iliac angioplasty is effect ive for managing patients with multilevel disease. The possibility of intraoperative digital substraction angioplasty and the use of no-prof ile co-axial balloon catheter design in the latter years of this study has improved our results.