Value of the profundapopliteal collateral index for selecting between an in-flow and sequential arterial reconstruction in patients with multisegmentarterial occlusive disease

Background. It remains difficult for surgeons to choose between an in-flow and sequential arterial reconstruction in patients with multisegment arteri al occlusive disease. In addition, the exact criterion for the proper revas cularization procedures of these patients also remains obscure. Methods. The profundapopliteal collateral index (PPCI) was determined in al l patients with occlusions of both the aortoiliac and superficial femoral a rteries prior to undergoing an arterial bypass. The PPCI in the inflow bypa ss (IB) was also compared with the sequential bypass (SB). Results, The symptoms of all patients undergoing either IB or SE improved. Preoperatively, the average PPCI in IB patients was significantly lower tha n that in SE patients. In addition, no significant difference was observed in the increased average rate of the ankle brachial index (ABI) between FB and SB. Conclusions. The PPCI is an accurate predictor of the hemodynamic potential of the geniculate collaterals. In cases with a low PPCI, especially in pat ients with multisegment arterial occlusive disease, in-flow procedures alon e may often be sufficient for the successful treatment of such patients. Th e PPCI is thus considered to be useful for selecting the optimal revascular ization procedures.