Combined percutaneous transluminal angioplasty, iliac stent deployment, and femorofemoral bypass for bilateral aortoiliac occlusive disease.

Background: We examine the technique of combining percutaneous transluminal angioplasty and secondary intravascular stent deployment with femorofemoral bypass graft in patients with bilateral aortoiliac occlusive disease.

Study Design: Retrospective review.

Results: During the 5-year period from June 1988 to October 1993, 18 patients with iliac occlusion and a hemodynamically significant contralateral iliac stenosis were treated using a combination of endovascular and open surgical techniques. Patients (13 men and 5 women) ranged in age from 50 to 78 years (mean, 64 years). Thirteen patients (72 percent) were treated for claudication, and 5 patients (28 percent) for rest pain or ulceration. Residual intra-arterial pressure gradients following percutaneous transluminal angioplasty or significant postpercutaneous transluminal angioplasty dissection were the indications for stent deployment in 15 and 3 patients, respectively. No operative deaths occurred, but 3 patients (16 percent) had early complications. Primary patency, as determined by life table analysis, was 100 percent, 79 percent, 62 percent, and 51 percent at 1, 2, 3, and 5 years, respectively. Secondary patency at 1, 2, 3, and 5 years was 100 percent, 93 percent, 75 percent, and 63 percent, respectively, with a mean follow-up of 41 months.

Conclusions: The combination of percutaneous transluminal angioplasty with primary or secondary stent deployment and femorofemoral bypass can be a useful option for treating iliac occlusion and contralateral iliac stenosis of less than 3 cm in length when the severity of the comorbid illnesses, advanced age, or the presence of prohibitive intra-abdominal pathology makes the avoidance of an abdominal incision desirable.