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《Chiese Journal of Surgery》 2001-01
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Combined intraoperative iliac artery stents and femoro-popliteal bypass for multilevel atherosclerotic occlusive disease

LIU Changwei, GUAN Heng, LI Yongjun, et al. Department of Surgery,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China  
Objective To study intraoperative iliac angioplasy and stenting combined with infrainquinal revascularization in multilevel atherosclerotic occlusive disease. [WT5”HZ]Methods[WT5”BZ] Intraoperative iliac angioplasty and stenting combined with simultaneous femoro popliteal bypass were performed on 12 lower extremities of 10 patients with multilevel atherosclerotic occlusive disease (8 men and 2 women, aged on average 72 years). The indications for the procedures included disabling claudication 3 patients and rest pain 7 (including tissue gangrenes in 2 patients). The mean preoperative ankle brachial index (ABI) was 0 31±0 21. [WT5”HZ]Results[WT5”BZ] Eleven iliac angioplasty and stent procedures were performed with simultaneous 9 femoro popliteal bypass and 3 femoro femoral popliteal bypass in the 12 limbs. Angioplasty and stent placement were successful in all patients. One contralateral femoral popliteal bypass failed after femoro femoral popliteal bypass because of poor outflow and prosthetic thrombosis; but the donor iliac stent and femoro femoral graft remained patent. There were no additional instances of procedural or postoperative morbidity or mortality, and no wound related complications. Postoperative ABI was 0 72±0 20 ( P 0 01). Follow up for 6 months on average (range 1 12 months) revealed that, one femoro infrapopliteal graft became occluded after 7 months as a result of thrombosis secondary to distal intimal hyperplasia and poor run off. Above knee amputation was required because of the failare of thrombectomy and thrombolysis and foot gangrene. The cumulative primary patency rate of stented iliac arteries and femoro popliteal bypass grafts was 100%(11/11) and 83 3%(10/12), respectively. All the femoro femoral bypass grafts were patent. The amputation rate was 8 3%(1/12). [WT5”HZ]Conclusions[WT5”BZ] Intraoperative iliac artery PTA and stent placement can be safely and effectively performed simultaneously with infrainguinal revascularization for multilevel atherosclerotic occlusive disease by skilled vascular surgeons, using a portable C arm fluoroscopy. Iliac artery PTA and stenting were valuable adjunct to distal bypass either to improve inflow and outflow or reduce the extent of traditional surgical intervention, and also, any angioplasty and stenting related complications can be immediately controlled.
【CateGory Index】: R654.4
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