Combined iliac transluminal angioplasty and femoropopliteal reconstruction for multilevel arterial occlusive disease.

Patients with multilevel arterial disease represent a challenging problem. A retrospective review of 46 consecutive femoropopliteal reconstructions combined with iliac balloon angioplasty was performed. Twenty-five procedures were below-knee and 21 to the above-knee popliteal artery segment. Mean follow-up was 26.8 months (range 4 to 84). There were 2 peroperative deaths and 3 serious complications (10.9%). In the late follow-up 4 significant restenoses and 1 reocclusion occurred for a patency rate of 81% for the inflow procedure at 5 years. Primary and secondary patency rate of combined procedures at 5 years was 61% and 76% respectively. The 5-year limb salvage rate was 93%. The mortality rate, morbidity rate and cumulative patency were not significantly different from a group of 38 patients who underwent 43 aortofemoral bypasses combined with femoropopliteal revascularization. In the latter group, the frequent incidence of anastomotic aneurysm (9.2%) was the main detrimental factor observed at follow-up. The authors conclude that femoropopliteal reconstruction combined with iliac angioplasty is effective for managing patients with multilevel disease. The possibility of intraoperative digital subtraction angioplasty and the use of no-profile co-axial balloon catheter design in the latter years of this study has improved our results.