COMBINATION ENDOVASCULAR AND OPEN TREATMENT OF PERIPHERAL ARTERIAL OCCLUSIVE DISEASE PERFORMED BY SURGEONS

The endovascular treatment of peripheral arterial occlusive disease ha s historically been performed by interventional radiologists and cardi ologists. With additional training in endovascular techniques, surgeon s become uniquely suited to manage arterial lesions with both endovasc ular and conventional surgical techniques, Over a 14-month period, 13 patients undenvent combination endovascular and open reconstruction on limbs with peripheral arterial occlusive disease. There were 10 males and 3 females. The mean age was 66 years. All procedures were perform ed in the operating room by surgery residents under the direct supervi sion of vascular surgeons. After intraoperative angiography, 26 arteri al lesions underwent percutaneous transluminal angioplasty (aorta, 1; common iliac, 14; external iliac, 10; superficial femoral, 1). Twenty- five of 26 lesions were further treated with intraluminal stent placem ent the lone exception being a case of superficial femoral artery angi oplasty. Concomitant open reconstruction was performed on all limbs, 1 4 as outflow and 1 as inflow. There were two cases of procedural morbi dity and one perioperative death secondary to myocardial infarction. T here were no wound-related complications. The mean ankle-brachial inde x of the affected lower extremity improved from 0.41 (+/- 0.15) to 0.7 4 (+/- 0.14) at 30 days. Mean follow-up was 8 months (range, 2-14). Ba sed on our early experience, simultaneous combination endovascular and open reconstruction of multisegment arterial occlusive disease can be performed safely and efficiently by surgeons.