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Chirurgia 2005 October;18(5):295-8


language: English

A new approach by surgical procedure and endovascular therapy for iliac occlusive disease

Ohtake H., Kimura K., Nagamine H., Kosugi I., Watanabe G., Sanada J., Matsui O.


Aim. The lesion in the iliac artery area is often continuous to aortic end and/or common femoral artery lesions. Therefore treatment requires accurate diagnosis and an appropriate protocol. In this report, our procedures and the short term result for iliac artery lesions are described.
Methods. From April 2001 to March 2004, 30 ischemic limbs due to iliac artery lesions of 23 cases were treated. Preoperative Fontaine classifications were IIb for 18 limbs, III for nine, and IV for three. The ankle brachial pressure index (ABPI) was 0.54. Occlusion in the abdominal aortic end was found in two cases; iliac artery occlusion was found in 20 limbs; iliac artery stenosis was found in 10 limbs; common femoral artery occlusion was found in 10 limbs. Endovascular therapy was planned as the first choice, and surgery was performed for cases outside indication for endovascular therapy.
Results. Sixteen limbs received only endovascular therapy. Stent placement was performed in 14 limbs (88%, 14/16). Surgical procedures were performed for fourteen limbs. There were no deaths in either surgical or endovascular therapeutic cases. In one endovascular therapeutic case, acute thrombosis occurred, and a thrombectomy was performed. Postoperatively, ischemic symptoms were improved in all of the cases. The postoperative ABPI was 0.83. There was no late mortality during 20 months follow-up. The short-term patency was 100% in the endovascular cases, and 85%/93% (primary/secondary) in the surgical cases.
Conclusion. Our treatment protocol resulted in good patency, without fatal complications. For iliac artery occlusion and stenosis, treatment combining surgical procedure and endovascular therapy is considered ideal.

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