Long-term effects of combined iliac dilatation and distal arterial surgery

Purpose: When standard aortofemoral surgical procedure is combined with low er extremity vascular surgery, problems related with the hospital stay, mor bidity, mortality and the cost of treatment will exist. The number of repor ts relating to combined iliac artery PTA and distal bypass surgery is limit ed. After the development of stenting procedures, the results of arterial s ystem plasty have much more improved. This report reviews our preliminary e xperience with iliac artery angioplasty with distal bypass procedures. Patients and Methods: A total of 41 patients have undergone combined iliac artery dilatation and distal arterial revascularization. Angioplastic proce dures were performed in the angiography suite and distal surgery was carrie d out at the same day or the day after. Of all patients, 29 underwent percu taneous transluminal angioplasty (PTA) and 12 underwent combined PTA and st ent placement. Ipsilateral femoropopliteal bypass was performed as a distal revascularization procedure in all patients. Results: Mean systolic iliac artery pressure gradients improved from 34.7 /- 8.6 mmHg to 3.9 +/- 3.2 mmHg after angioplastic procedures (P < 0.0001). Six patients needed re-angioplasty because of restenosis in the follow-up period. Thrombectomy was performed on 1 patient in the early postoperative period and re-do femoropopliteal bypass was performed on two patients in th e 2nd and 23rd months. Three minor wound infections were successfully treat ed with antibiotics and local care. Mean follow-up was 21.4 months (range 1 -48 months). By life-table analyses, the overall 4-year cumulative primary patency of combined procedures was 78.1%. Conclusion: The results show that the combined procedure is a suitable meth od for the treatment of patients with multiple stenotic lesions at the ilia c and distal arterial levels. We believe that the combined use of PTA and d istal vascular surgery by an experienced surgical team will give beneficial results and a highly satisfactory outcome in this group of patients.