A COMPARISON OF OPERATIVE APPROACHES AND PARAMETERS PREDICTIVE OF SUCCESS IN MULTILEVEL ARTERIAL OCCLUSIVE DISEASE

BACKGROUND: The correction of abnormal inflow alone in patients with m ultilevel arterial occlusive disease (MLAOD) may be inadequate to reli eve limb-threatening ischemia. This: study was undertaken to compare o perative approaches and attempt to define preoperative parameters pred ictive of limb salvage in patients with MLAOD. STUDY DESIGN: The outco me after revascularization for 194 patients with limb-threatening isch emia MLAOD was assessed retrospectively. One hundred fifty-one patient s initially underwent an inflow operation alone. Based on whether or n ot these patients required an outflow operation within one year, they were divided into two groups: group 1, no outflow operation (121 patie nts, 121 limbs), and group 2, outflow operation required for continued ischemic symptoms (30 patients, 30 limbs). A separate group of forty- three patients (43 limbs) underwent synchronous inflow-outflow operati ons, or multilevel revascularization, as their initial operative proce dure (group 3). RESULTS: Perioperative complications and mortality rat es did not differ between groups. Limb salvage rates were similar for groups 1 and 3, whereas in group 2, limb salvage rates were significan tly reduced (p=0.0184). Long-term limb salvage after an isolated inflo w procedure was associated with lack of prior vascular reconstructions (p=0.0002), the absence of tissue loss (p=0.0019), and an infragenciu late angiographic runoff score of less than 6 (p=0.054). CONCLUSIONS: In patients with limb-threatening MLAOD, synchronous inflow-outflow op erations can be performed with resultant morbidity and mortality rates comparable with inflow alone. After an inflow operation, the approach of ''expectant management'' may ultimately compromise limb salvage if a subsequent outflow operation is required.