D. Melliere et al., Indications and benefits of simultaneous endoluminal balloon angioplasty and open surgery during elective lower limb revascularization, CARDIOV SUR, 7(2), 1999, pp. 242-246
Combined balloon angioplasty and conventional revascularization are occasio
nally performed but some points are still controversial: which patients are
eligible for this associated procedure?; should the procedures be performe
d simultaneously or successively?; and in case of simultaneous procedure, w
hich one should be performed first? To answer these questions, the notes of
64 patients consecutively submitted to this procedure at the Henri Mondor
hospital were reviewed. Arterial dilatation was performed on the iliac arte
ry, superficial femoral artery, popliteal artery or tibioperoneal trunk in
31, 26, four and four patients, respectively. Reasons for simultaneous proc
edures were multiple occlusive lesions in 67% of patients and inflow improv
ement in 14%. The others reasons included iliac obstruction in poor risk pa
tients, unilateral failure of planned bilateral iliac balloon angioplasty,
outflow improvement, local contraindication to arterial approach, shortness
of vein graft, clamp injury during open surgery and inadequate patient pos
ition for both procedures. Complications were rare, One patient died of rec
urrent sepsis of the femoro-femoral bypass. The S-year limb salvage rate wa
s 91%. In this study, simultaneous procedures were associated with three ad
vantages: the risk of septic complications associated with graft implantati
ons in a previously punctured site was decreased, anticoagulant and/or anti
platelet therapy did not need to be modified before the second procedure, h
ospital length of stay and cost appeared to be lower, On a simultaneous pro
cedure, it is recommended that the balloon angioplasty be performed after t
he conventional procedure in order to avoid clamping a recently dilated art
ery when performing the bypass. (C) 1999 The International Society for Card
iovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.