Combined percutaneous transluminal angioplasty and extraanatomic bypass for symptomatic unilateral iliac artery occlusion with contralateral iliac artery stenosis |
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Authors: | Philip J Walker FRACS John P Harris MS FRACS FRCS FACS DDU James May MS FRACS FACS Jerry Goldstone MD |
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Institution: | (1) Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, Australia;(2) Department of Surgery, University of Sydney, Blackburn Building, 2006 Sydney, NSW, Australia;(3) San Francisco, California |
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Abstract: | We have reviewed our experience with percutaneous transluminal angioplasty of contralateral iliac stenosis and extraanatomic
bypass of the occluded iliac artery. Twenty-two men and nine women with a mean age of 65 years (range 46 to 84) presented
with symptomatic iliac occlusive disease. Twenty-four (77%) had disabling claudication, four (13%) rest pain, and three (10%)
ischemic tissue loss. Six (19%) had undergone previous vascular reconstructive procedures. All had an occluded iliac artery
on the symptomatic side and greater than 50% stenosis of the contralateral iliac artery. Percutaneous transluminal angioplasty
of the iliac stenosis was done prior to extraanatomic bypass, using polytetrafluoroethylene. There were six late deaths after
discharge. The only significant complication was a femoral artery thrombosis which was corrected when the bypass graft was
performed. Cumulative primary graft patency was 89% at one year and 81% at three years. The crossover graft occluded in six
patients, five within 48 months of surgery, and one after nine years. One of these occluded grafts was salvaged by thrombectomy,
for a secondary patency rate of 85% at three years. Two patients required aortobifemoral bypass, one an iliobifemoral bypass
and one an ilioprofunda bypass. One patient operated upon for rest pain came to below-knee amputation. Mean resting ankle/brachial
systolic pressure index increased significantly on the side of the iliac occlusion from 0.35 ±0.21 to 0.70 ± 0.20 (p < 0.05,
paired t test) after the combined procedure. There was no significant difference in the mean resting ankle/brachial systolic
pressure index on the contralateral side (0.60 ± 0.22 to 0.65 ± 0.27, ns). Combined iliac percutaneous transluminal angioplasty
and femorofemoral bypass is a safe alternative to aortobifemoral bypass for selected patients with aortoiliac arterial occlusive
disease.
Presented at the Royal Australasian College of Surgeons, General Scientific Meeting, May 1989, Melbourne, Australia. |
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Keywords: | Iliac artery iliac occlusion contralateral iliac stenosis percutaneous transluminal angioplasty extraanatomic bypass |
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