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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2000 March;7(1):1-12

language: English, Italian

Extension of indications for femorofemoral crossover bypass. Usefulness of donor iliac PTA

Ippoliti A., Ascoli Marchetti A., Di Giulio L., Raimondo Pistolese G.

From the Department of Postgraduate School of Vascular Surgery “Tor Vergata” University of Rome, Rome, Italy


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Background and pur­pose. Extension of indi­ca­tions for fem­o­rof­e­mo­ral cross­over ­bypass to ­patients ­with occlu­sive ­lesions of the ­donor ­iliac ­axis suit­able for PTA.
Methods. We eval­u­at­ed 10 ­patients under­go­ing fem­o­rof­e­mo­ral cross­over ­bypass ­after PTA of the ­donor ­iliac ­artery ­between March 1988 and March 1999: 3 at ­stage 2B ­with dis­abling claud­i­ca­tion; 3 ­with rest­ing ­pain; 4 ­with troph­ic ­lesions. The ­mean age of ­patients was 67 ­years. All ­patients under­went ultra­so­nog­ra­phy and dig­i­tal arter­i­og­ra­phy (DSA). Extra-ana­tom­ic revas­cu­lar­iza­tion was sug­gest­ed in 9 ­patients who pre­sent­ed a gen­er­al­ly ­high sur­gi­cal ­risk, and in 1 ­patient ­owing to ­local tech­ni­cal dif­fi­cul­ties. The ­mean ­ankle/arm pres­sure ­index was 0.72 in the ­donor ­limb (min 0.65-max 0.81) and 0.29 (min 0.23-max 0.42) in the recip­i­ent ­limb. Eight ste­nos­es of the com­mon ­iliac ­artery (80%) and 2 (20%) of the exter­nal ­artery ­were treat­ed ­using PTA; an endo­lu­mi­nal ­stent was posi­tioned in 8 cas­es. Mean fol­low-up: 56 ­months.
Results. No imme­di­ate com­pli­ca­tion was report­ed ­after endo­vas­cu­lar treat­ment; the ­mean ­ankle/arm pres­sure ­index of the ­donor ­iliac ­axis ­rose to 0.88 ­after PTA and to 0.54 in the recip­i­ent ­limb ­after ­bypass. Walking dis­tance ­improved in 3 cas­es, and rest­ing ­pain dis­ap­peared in 2 ­patients; troph­ic ­lesions ­healed in ­three ­patients. Two (20%) ­major ampu­ta­tions ­were ­required at 18 and 22 ­months in dia­bet­ic ­patients.
Conclusions. Femorofemoral cross­over ­bypass rep­re­sents a val­id alter­na­tive in ­high-­risk ­patients. By increas­ing ­inflow, PTA of the ­donor ­iliac ­axis guar­an­tees ­graft paten­cy and ­good leg per­fu­sion.

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