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. 2015;8(1):14-20.
doi: 10.3400/avd.oa.14-00119. Epub 2015 Feb 16.

Long-term results of combined aortoiliac and infrainguinal arterial reconstruction for the treatment of critical limb ischemia

Takuya Miyahara  1 , Kunihiro Shigematsu  1 , Ayako Nishiyama  1 , Takuya Hashimoto  1 , Katsuyuki Hoshina  1 , Toshiaki Watanabe  1
Affiliations

Long-term results of combined aortoiliac and infrainguinal arterial reconstruction for the treatment of critical limb ischemia

Takuya Miyahara et al. Ann Vasc Dis. 2015.

Abstract

Objective: This study was designed to investigate our long-term experience with combined iliac endovascular therapy (EVT) and infrainguinal bypass to treat critical limb ischemia (CLI) and compare outcomes to those of patients who underwent surgery for aortoiliac lesions.

Materials and methods: From April 2000 to June 2013, 57 patients (58 limbs) underwent an infrainguinal bypass combined with aortoiliac reconstruction to treat CLI. Eighteen limbs were treated by bypass alone and 8 limbs were treated by bypass with EVT for aortoiliac lesions (Bypass group). Thirty-two limbs were subjected to EVT alone for iliac lesions (EVT group).

Results: Preoperative limb ischemia was more severe in the EVT group. There were no significant differences in major procedure-related complications (χ(2) test, P = 0.853), systemic complications (P = 0.853), and mortality (P = 0.916) between the 2 groups. The limb salvage rates were 92% at 1, 3, and 5 years in the Bypass group and 93% at 1, 3, and 5 years in the EVT group, with no significant difference observed between the groups (Kaplan-Meier, log-rank test, P = 0.616).

Conclusion: Infrainguinal surgical reconstruction combined with an iliac EVT is an acceptable strategy for managing patients with CLI.

Keywords: critical limb ischemia; endovascular treatment; hybrid procedure.

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Figures

Fig. 1
Fig. 1
Procedures for repairing aortoiliac lesions in the Bypass and endovascular therapy (EVT) groups. Ao-F, aortofemoral; I-F, iliofemoral; Ax-F, axillofemoral.
Fig. 2
Fig. 2
Cumulative primary (A) and secondary (B) patency rates in the Bypass and endovascular therapy (EVT) groups. There were no significant differences in the primary or secondary patency rates between the two groups (Kaplan-Meier, log-rank test, primary patency, P = 0.933; secondary patency, P = 0.113). The dotted line denotes SEM >10%. SEM: standard error of the mean.
Fig. 3
Fig. 3
Limb salvage (A) and survival (B) rates in the Bypass and endovascular therapy (EVT) groups. There were no significant differences in limb salvage or survival rates between the two groups (Kaplan-Meier, log-rank test, limb salvage, P = 0.616; survival, P = 0.397). The dotted line denotes SEM >10%. SEM: standard error of the mean.
See this image and copyright information in PMC

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