INTRAOPERATIVE ENDOVASCULAR ANGIOPLASTY AND STENTING OF ILIAC ARTERY - AN ADJUNCT TO FEMOROPOPLITEAL BYPASS

Background: With the rapid development of endovascular techniques, the management strategy of patients with multilevel atherosclerotic arter ial occlusive disease is also evolving. Iliac artery stenting is a mea ns whereby multiple bypass operations can be avoided in such patients. The early results of preoperative iliac artery stenting seem promisin g but the role of intraoperative iliac artery angioplasty and stenting is less clear. Study Design: This study was undertaken to evaluate ou r early results of a combined endovascular and operative approach to p atients with multilevel atherosclerotic arterial occlusive disease. Be tween June 1995 and March 1997, primary intraoperative iliac artery ba lloon angioplasty and stent placement were performed on 13 affected li mbs of 12 patients undergoing an infrainguinal bypass operation. Indic ations for operation, patient demographics, and risk factors were note d. The outcome of surgery and the patency rates of bypass graft and st ent were also recorded. Results: The initial technical success of prim ary iliac artery angioplasty and stenting was 93%. An improvement of t he ankle-brachial index by a mean value of 0.38 was attained after ope ration (p < 0.001). Clinical success, based on the criteria suggested by the Society for Vascular Surgery/International Society for Cardiova scular Surgery, was achieved in all patients. There was no operative o r hospital mortality. Postoperative morbidity rate was 8% (n = 1). The cumulative 1-year patency rates of iliac stent and infra-inguinal byp ass grafts were 100% and 85%, respectively. The limb loss rate was 7%. Conclusions: The technique of intraoperative angioplasty and stenting can be easily mastered by an experienced and skilled vascular surgeon , using a portable C-arm fluoroscopic unit, in the operation theater. A combined endovascular and operative approach optimizes the therapeut ic option to this selected group of patients. (C) 1998 by the American College of Surgeons.