TY - JOUR
T1 - Efficacy of iliac inflow repair in patients with concomitant iliac and superficial femoral artery occlusive disease
AU - Akamatsu, Daijirou
AU - Goto, Hitoshi
AU - Kamei, Takashi
AU - Miyagi, Shigehito
AU - Tsuchida, Ken
AU - Kawamura, Keiichiro
AU - Tajima, Yuta
AU - Umetsu, Michihisa
AU - Watanabe, Tetsuo
AU - Ohuchi, Noriaki
N1 - Publisher Copyright:
© 2016
PY - 2017/11
Y1 - 2017/11
N2 - Background In multilevel arterial disease, whether complete revascularization or staged runoff repair should be performed remains controversial. The aim of this study was to evaluate the efficacy of iliac inflow repair and to identify clinical conditions that are associated with the need for runoff repair in concomitant iliac and superficial femoral artery (SFA) occlusive disease. Methods Patients undergoing inflow repair for complicated flow-limiting iliac lesions with diffuse SFA disease between 2007 and 2013 were retrospectively reviewed. Patients with poor response to inflow repair underwent infrainguinal revascularization (IIR). Results The 29 ischemic limbs examined in this study represent 26 different patients (22 males; mean age, 77 ± 8 years). Indications for inflow repair were Rutherford Classifications III (31%), IV (31%), V (31%), and VI (7%). Severity of the complicated SFA disease was either TASC (TransAtlantic Inter-Society Consensus) type C (14%) or type D (86%). Overall, freedom from IIR was 90% after 30 days and 83% after 1 year. Patients having claudication, rest pain, and shallow ischemic ulcers experienced the relief of symptoms, whereas patients with deep gangrene that needed minor amputation required IIR more frequently (p < 0.01). Anatomical risk factors for poor response to inflow repair were poor quality of the deep femoral artery (p < 0.01) and the flow-limiting popliteal artery (p = 0.02), and poor below-knee runoff (≤ 1 vessel, p < 0.01). Conclusion Iliac inflow repair can reverse the symptoms in patients with multilevel arterial occlusive disease that are not associated with gangrenous toes.
AB - Background In multilevel arterial disease, whether complete revascularization or staged runoff repair should be performed remains controversial. The aim of this study was to evaluate the efficacy of iliac inflow repair and to identify clinical conditions that are associated with the need for runoff repair in concomitant iliac and superficial femoral artery (SFA) occlusive disease. Methods Patients undergoing inflow repair for complicated flow-limiting iliac lesions with diffuse SFA disease between 2007 and 2013 were retrospectively reviewed. Patients with poor response to inflow repair underwent infrainguinal revascularization (IIR). Results The 29 ischemic limbs examined in this study represent 26 different patients (22 males; mean age, 77 ± 8 years). Indications for inflow repair were Rutherford Classifications III (31%), IV (31%), V (31%), and VI (7%). Severity of the complicated SFA disease was either TASC (TransAtlantic Inter-Society Consensus) type C (14%) or type D (86%). Overall, freedom from IIR was 90% after 30 days and 83% after 1 year. Patients having claudication, rest pain, and shallow ischemic ulcers experienced the relief of symptoms, whereas patients with deep gangrene that needed minor amputation required IIR more frequently (p < 0.01). Anatomical risk factors for poor response to inflow repair were poor quality of the deep femoral artery (p < 0.01) and the flow-limiting popliteal artery (p = 0.02), and poor below-knee runoff (≤ 1 vessel, p < 0.01). Conclusion Iliac inflow repair can reverse the symptoms in patients with multilevel arterial occlusive disease that are not associated with gangrenous toes.
KW - iliac artery
KW - inflow repair
KW - multilevel arterial disease
KW - peripheral artery disease
KW - superficial femoral artery
UR - http://www.scopus.com/inward/record.url?scp=84979695342&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84979695342&partnerID=8YFLogxK
U2 - 10.1016/j.asjsur.2016.07.004
DO - 10.1016/j.asjsur.2016.07.004
M3 - Article
C2 - 27451009
AN - SCOPUS:84979695342
VL - 40
SP - 475
EP - 480
JO - Asian Journal of Surgery
JF - Asian Journal of Surgery
SN - 1015-9584
IS - 6
ER -