Indications and benefits of simultaneous endoluminal balloon angioplasty and open surgery during elective lower limb revascularization

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.