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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
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
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.