Operative management of multilevel iliofemoral occlusive disease

BACKGROUND: The current trend is to treat both inflow and outflow occlusive disease using endovascular procedures either simultaneously or in a staged procedure. The long-term benefits of a combined one-stage approach are not available. OBJECTIVES: The main objectives are to investigate the risks and long-term benefits of a combined one-stage approach using endovas- cular techniques for iliac occlusive disease and bypass for femoro- popliteal occlusive disease. METHODS and RESULTS: Fifty-three patients with limb ischemia underwent combined ilial stenting and distal bypass. Complications included minor wound problems in nine patients, atrial fibrillations in one patient, acute graft occlusion in one patient, toe amputation in two patients and one death. During a follow-up period of up to 96 months, eight patients required repeat distal bypass, five patients underwent revascularization on contralateral sides and four patients had repeat endovascular procedures. CONCLUSION: These results suggest that there are few risks with a combined endovascular procedure for iliac occlusion and bypass for femoropopliteal occlusive disease. Long-term complications with the combined approach included repeat distal bypass, revascularization on contralateral sides and repeat endovascular procedure.