Combined iliac angioplasty and infrainguinal revascularization surgery areeffective in diabetic patients with multilevel arterial disease

The success of percutaneous transluminal angioplasty (PTA) in the treatment of common and external iliac atherosclerotic lesions has been established for the general population. However, several studies have suggested that th e presence of diabetes may reduce the effectiveness of iliac angioplasty, p articularly in the setting of limb-threatening ischemia requiring concomita nt lower extremity revascularization. This study compared the results of il iac artery PTA performed in conjunction with infrainguinal bypass for limb- threatening ischemia for diabetic (DM) and nondiabetic (non-DM) patients. B etween 1991 and 2000, 159 PTA were performed in 126 patients (DM = 99/79%, non-DM = 27/21%) in conjunction with subsequent infrainguinal bypass for li mb-threatening ischemia (gangrene = 42%, ulcer = 36%, rest pain = 22%). The se patients were followed prospectively using a computerized vascular regis try. Stents were placed in 34 (21.4%) cases for suboptimal angioplasty resu lts. In this study the combined use of standard surgical and endoluminal mo dalities for the treatment of multilevel arterial occlusive disease resulte d in excellent cumulative patency and limb salvage rates. The presence of d iabetes did not alter these favorable results. Multimodal vascular therapy may be used effectively in diabetic patients with limb-threatening ischemia due to multiple levels of arterial occlusion.