Surgical Treatment of Occlusive Vascular Disease in the Elderly

  • William D. Suggs
  • Frank J. Veith
  • Luis A. Sanchez


Severe arterial occlusive disease can manifest as incapacitating claudication or limb-threatening ischemia of the lower extremities. Male cigarette smokers under the age of 65 have been considered in the past as the group with the highest prevalence of aortoiliac occlusive disease. Over the past 20 years it has been noted that there are increasing numbers of women affected with occlusive disease of the aortoiliac segment.1 In addition, with the “graying” of the population and the increased life expectancy of individuals, the number of elderly patients presenting with significant aortoiliac occlusive disease is continuously increasing and becoming a significant and increasing percentage of the patients who require intervention for this disease.2 During the 1990s, the average age of patients requiring aortoiliac reconstructions at our institution increased from 63 years to 68 years. The options for treatment of aortoiliac occlusive disease have evolved since the 1950s, when the initial aortoiliac reconstructions were performed using an arterial prosthesis. Multiple options for arterial reconstructions have been developed to accommodate varied patient arterial anatomy and risks of intervention. Advances in catheter-based techniques, vascular imaging, and other noninvasive tests have paralleled the development of new surgical techniques and procedures. Further advances in the treatment of aortoiliac occlusive disease are based on the combination of percutaneous techniques and surgical skills used to develop and perform endolu-minal bypass.


Patency Rate Occlusive Disease Limb Salvage Popliteal Artery Primary Patency Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Cronenwett JL, Davis JR Jr, Gooch JB, et al. Aortoiliac occlusive disease in women. Surgery 1980;88:775–784.PubMedGoogle Scholar
  2. 2.
    Veith FJ, Gupta SK, Wengerter KR, et al. Changing atherosclerotic disease patterns and management strategies in lower-limb threatening ischemia. Ann Surg 1990;212: 402–414.PubMedCrossRefGoogle Scholar
  3. 3.
    Ascer E, Veith FJ, Gupta SK. Bypasses to plantar arteries and other tibial branches. J Vasc Surg 1988;8:434–441.PubMedGoogle Scholar
  4. 4.
    Moneta GL, Yeager RA, Taylor LM Jr, et al. Hemodynamic assessment of combined aortoiliac/femoropopliteal occlusive disease and selection of single or multilevel revascularization. Semin Vasc Surg 1994;7:3–10.PubMedGoogle Scholar
  5. 5.
    Baker JD, Dix D. Variability of Doppler ankle pressures with arterial occlusive disease: an evaluation of ankle index and brachial-ankle pressure gradient. Surgery 1976;79:134–137.Google Scholar
  6. 6.
    Kohler TR, Nance DR, Cramer MM, et al. Duplex scanning for diagnosis of aortoiliac and femoropopliteal disease: a prospective study. Circulation 1987;76:1074–1080.PubMedCrossRefGoogle Scholar
  7. 7.
    Langsfeld M, Nupute J, Hershey FB, et al. The use of deep duplex scanning to predict hemodynamically significant aortoiliac stenoses. J Vasc Surg 1988;7:395–399.PubMedGoogle Scholar
  8. 8.
    Moneta GL, Yeager RA, Antonovic R, et al. Accuracy of lower extremity arterial duplex mapping. J Vasc Surg 1992; 15:275–284.PubMedCrossRefGoogle Scholar
  9. 9.
    Legemate DA, Teeuwen C, Hoenveld H, et al. Value of duplex scanning compared with angiography and pressure measurement in the assessment of aortoiliac lesions. Br J Surg 1991;78:1003–1008.PubMedCrossRefGoogle Scholar
  10. 10.
    Owens RS, Carpenter JP, Baum RA, et al. Magnetic resonance imaging of angiographically occult runoff vessels in peripheral arterial occlusive disease. N Engl J Med 1992; 326:1577–1581.CrossRefGoogle Scholar
  11. 11.
    Carpenter JP, Owens RS, Baum RA, et al. Magnetic resonance angiography of peripheral runoff vessels. J Vasc Surg 1992;16:807–815.PubMedCrossRefGoogle Scholar
  12. 12.
    Carpenter JP, Owens RS, Holland GA, et al. Magnetic resonance angiography of the aorta, iliac, and femoral arteries. Surgery 1994;116:17–23.PubMedGoogle Scholar
  13. 13.
    Arlart IP, Guhl L, Edleman RR. Magnetic resonance angiography of the abdominal aorta. Cardiovasc Intervent Radiol 1992;15:43.PubMedCrossRefGoogle Scholar
  14. 14.
    Brewster DC, Waltman AC, O’Hara PJ, et al. Femoral artery pressure measurement during aortography. Circulation 60:120–124.Google Scholar
  15. 15.
    Hessel SJ, Adams DF, Abrams HL. Complications of angiography. Radiology 1981;138:273–281.PubMedGoogle Scholar
  16. 16.
    Gomes AS, Baker JD, Martin-Paredero V, et al. Acute renal dysfunction after major arteriography. AJR 1985;145:1249–1253.PubMedCrossRefGoogle Scholar
  17. 17.
    Martin-Paredero V, Dixon SM, Baker JD, et al. Risk of renal failure after major angiography. Arch Surg 1983;118:1417–1420.PubMedCrossRefGoogle Scholar
  18. 18.
    Nikonoff T, Skau T, Berglund J, et al. Effects of femoral arteriography and low osmolar contrast agents on renal function. Acta Radiol 1993;34:88–91.PubMedGoogle Scholar
  19. 19.
    Katholi RE, Taylor GJ, Woods WT, et al. Nephrotoxicity of nonionic low-osmolality versus ionic high-osmolality contrast media: a prospective double-blind randomized comparison in human beings. Radiology 1993;186:183–187.PubMedGoogle Scholar
  20. 20.
    Lautin EM, Freeman NJ, Schoenfeld AH, et al. Radiocontrast-associated renal dysfunction: a comparison of lower-osmolality and conventional high-osmolality contrast media. AJR 1991;157:59–65.PubMedCrossRefGoogle Scholar
  21. 21.
    Hall KA, Wong RW, Hunger GC, et al. Contrast-induced nephrotoxicity: the effects of vasodilator therapy J Surg Res 1992;53:317–320.Google Scholar
  22. 22.
    Johnston KW, Rae M, Hogg-Johnston SA, et al. 5-Year results of a prospective study of percutaneous transluminal angioplasty. Ann Surg 1987;206:403.PubMedCrossRefGoogle Scholar
  23. 23.
    Ravimandalam K, Rao VRK, Kumar S, et al. Obstruction of the infrarenal portion of the abdominal aorta: results of treatment with balloon angioplasty AJR 1991;156:1257–1262.Google Scholar
  24. 24.
    Odunry A, Colapinto RF, Sniderman KW, et al. Percutaneous transluminal angioplasty of abdominal aortic stenoses. Cardiovasc Intervent Radiol 1989;12:1–6.CrossRefGoogle Scholar
  25. 25.
    Yakes WF, Kumpe DA, Brown SB, et al. Percutaneous transluminal aortic angioplasty: techniques and results. Radiology 1989;172:965–970.PubMedCrossRefGoogle Scholar
  26. 26.
    Marin ML, Veith FJ, Cynamon J, et al. Transfemoral endovascular stented graft treatment of aortoiliac and femoropopliteal occlusive disease for limb salvage. Am J Surg 1994;168:156–162.PubMedCrossRefGoogle Scholar
  27. 27.
    Becker GJ, Katzen BT, Dake MD. Noncoronary angioplasty. Radiology 1989;170:403–412.Google Scholar
  28. 28.
    Gallino A, Mahler F, Probst P, et al. Percutaneous transluminal angioplasty of the arteries of the lower limbs: a 5-year follow-up. Circulation 1984;70:619–623.PubMedCrossRefGoogle Scholar
  29. 29.
    Spence RK, Freiman DB, Gatenby R, et al. Long-term results of transluminal angioplasty of the iliac and femoral arteries. Arch Surg 1981;116:1377–1386.PubMedCrossRefGoogle Scholar
  30. 30.
    Stokes KR, Strunk HM, Campbell DR, et al. Five-year results of iliac and femoropopliteal angioplasty in diabetic patients. Radiology 1990;174:977–982.PubMedGoogle Scholar
  31. 31.
    Palmaz JC, Garcia OJ, Schatz RA, et al. Placement of balloon-expandable intraluminal stents in iliac arteries: first 171 procedures. Radiology 1990;174:969–975.PubMedGoogle Scholar
  32. 32.
    Richter GM, Roeren T, Brado M, et al. Further update of the randomized trial: iliac stent placement versus PTA-morphology, clinical success rates, and failure analysis. J Vasc Interv Radiol 1993;4:30.Google Scholar
  33. 33.
    Liermann D, Strecker EP, Peters J. The Strecker stent: indications and results in iliac and femoropopliteal arteries. Cardiovasc Intervent Radiol 1992;15:298.PubMedCrossRefGoogle Scholar
  34. 34.
    Palmaz JC, Laborde JC, Rivera FJ, et al. Stenting of the iliac arteries with the Palmaz stent: experience from a multicen-ter trial. Cardiovasc Intervent Radiol 1992;15:291–297.PubMedCrossRefGoogle Scholar
  35. 35.
    Hausegger KA, Cragg AH, Lammer J, et al. Iliac artery stent placement: clinical experience with a Nitinol stent. Radiology 1994;190:199–202.PubMedGoogle Scholar
  36. 36.
    Vorwerk D, Gunther RW. Stent placement in iliac arterial lesions: three years of clinical experience with the Wallstent. Cardiovasc Intervent Radiol 1992;15:285–290.PubMedCrossRefGoogle Scholar
  37. 37.
    Vorwerk D, Gunther RW. Chronic iliac artery occlusion. Presented at the International Congress, University of Heidelberg, Zermatt, April 1993.Google Scholar
  38. 38.
    Blair JM, Gewertz BL, Mossa H, et al. Percutaneous transluminal angioplasty versus surgery for limb-threatening ischemia. J Vasc Surg 1989;9:698–703.PubMedGoogle Scholar
  39. 39.
    Becker GJ, Katzen BT, Dake MK. Noncoronary angioplasty. Radiology 1989;170:921–940.PubMedGoogle Scholar
  40. 40.
    Wilson SE, Wolf GL, Cross AP. Percutaneous transluminal angioplasty versus operation for peripheral arteriosclerosis. J Vasc Surg 1989;9:1–9.PubMedGoogle Scholar
  41. 41.
    Murray RR, Hewes RC, White RI, et al. Long-segment femoropopliteal stenosis: is angioplasty a boon or a bust? Radiology 1987;162:473–476.PubMedGoogle Scholar
  42. 42.
    Hunink MM, Wong JB, Donaldson MC, et al. Patency results of percutaneous and surgical revascularization for femoro-poplitealerial arterial disease. Med Decis Making 1994;14: 17–81.Google Scholar
  43. 43.
    Treiman GS, Treiman RL, Ichikawa L, et al. Should percutaneous transluminal angioplasty be recommended for treatment of infrageniculate popliteal artery or tibioper-oneal trunk stenosis? J Vasc Surg 1995;22:457–465.PubMedCrossRefGoogle Scholar
  44. 44.
    London NJ, Varty K, Sayers RD, et al. Percutaneous transluminal angioplasty for lower-limb critical ischaemia. Br J Surg 1995;82:1232–1235.PubMedCrossRefGoogle Scholar
  45. 45.
    Currie IC, Wakeley CJ, Cole SEA, et al. Femoropopliteal angioplasty for severe limb ischaemia. Br J Surg 1994;81: 191–193.PubMedCrossRefGoogle Scholar
  46. 46.
    Stanley B, Teague B, Raptis S, et al. Efficacy of balloon angioplasty of the superficial femoral artery and popliteal artery in the relief of leg ischemia. J Vasc Surg 1994;23:679–685.CrossRefGoogle Scholar
  47. 47.
    Brewster DC, Darling RC. Optimal methods of aortoiliac reconstruction. Surgery 1978;84:739–748.PubMedGoogle Scholar
  48. 48.
    Piotrowski JJ, Pearce WH, Jones DN, et al. Aortobifemoral bypass: the operation of choice for unilateral iliac occlusion? J Vasc Surg 1988;8:211–218.PubMedGoogle Scholar
  49. 49.
    Schneider JR, Besso SR, Walsh DB, et al. Femorofemoral versus aortobifemoral bypass: outcome and hemodynamic results. J Vasc Surg 1994;19:43–57.PubMedCrossRefGoogle Scholar
  50. 50.
    Passman MA, Taylor LM Jr, Moneta GL, et al. Comparison of axillofemoral and aortofemoral bypass for aortoiliac occlusive disease. J Vasc Surg 1996;23:263–271.PubMedCrossRefGoogle Scholar
  51. 51.
    Hanafy M, McLoughlin GA. Comparison of iliofemoral and femorofemoral crossover bypass in the treatment of unilateral iliac arterial occlusive disease. Br J Surg 1991;78:1001–1002.PubMedCrossRefGoogle Scholar
  52. 52.
    Harrington ME, Harrington EB, Haimov M, et al. Iliofemoral versus femorofemoral bypass: the case for an individualized approach. J Vasc Surg 1992;16:841–842.PubMedCrossRefGoogle Scholar
  53. 53.
    Farber MA, Hollier LH, Eubanks R, et al. Femorofemoral bypass: a profile of graft failure. South Med J 1990;83: 1437–1443.PubMedCrossRefGoogle Scholar
  54. 54.
    Nolan KD, Benjamin ME, Murphy TJ, et al. Femorofemoral bypass for aortofemoral graft limb occlusion: a ten-year experience. J Vasc Surg 1994;19:851–857.PubMedCrossRefGoogle Scholar
  55. 55.
    . Kenney DA, Sauvage LR, Wood SJ, et al. Comparison of noncrimped, externally supported (EXS) and crimped, nonsupported Dacron prostheses for axillofemoral and above-knee femoropopliteal bypass. Surgery 1982;92:931–946.PubMedGoogle Scholar
  56. 56.
    El-Massry S, Saad E, Sauvage LR, et al. Axillofemoral bypass with externally supported, knitted Dacron grafts: a follow-up through twelve years. J Vasc Surg 1993;17:107–115.PubMedCrossRefGoogle Scholar
  57. 57.
    . Taylor LM Jr, Moneta GL, McConnell DB, et al. Axillofemoral grafting with externally supported polytetrafluo-roethylene. Arch Surg 1994;129:588–595.PubMedCrossRefGoogle Scholar
  58. 58.
    Harrington ME, Harrington, EB, Haimov M, et al. Axillofemoral bypass: compromised bypass for compromised patients. J Vasc Surg 1994;20:195–201.PubMedCrossRefGoogle Scholar
  59. 59.
    Martin EC. Percutaneous therapy in the management of aortoiliac disease. Semin Vasc Surg 1994;7:17.PubMedGoogle Scholar
  60. 60.
    Tegtmeyer CJ, Hartwell GD, Selby JB, et al. Results and complications of angioplasty in aortoiliac disease. Circulation 1991;83(suppl I):53–60.Google Scholar
  61. 61.
    Johnston KW. Iliac arteries: reanalysis of results of balloon angioplasty. Radiology 1993;186:207–212.PubMedGoogle Scholar
  62. 62.
    Marin ML, Veith FJ, Sanchez LA, et al. Endovascular aortoiliac grafts in combination with standard infrainguinal arterial bypasses in the management of limb-threatening ischemia: preliminary report. J Vasc Surg 1995;22:316–325.PubMedCrossRefGoogle Scholar
  63. 63.
    Veith FJ, Gupta SK, Daly V. Femoropopliteal bypass to the isolated popliteal segment: is polytetrafluoroethylene graft acceptable? Surgery 1981;89:296.PubMedGoogle Scholar
  64. 64.
    Kram HB, Gupta SK, Veith FJ, et al. Late results of 217 femoropopliteal bypasses to isolated popliteal segments. J Vasc Surg 1991;14:386.PubMedCrossRefGoogle Scholar
  65. 65.
    Rinn WR, Flanigan DP, Verta MJ, et al. Sequential femoroal-tibial bypass for severe limb ischemia. Surgery 1980;88: 357.Google Scholar
  66. 66.
    Veith FJ, Ascer E, Gupta SK. Tibiotibial vein bypass grafts: a new operation for limb salvage. J Vase Surg 1995;2: 552.Google Scholar
  67. 67.
    Ascer E, Veith FJ, Gupta SK. Bypasses to plantar arteries and other tibial branches: an extended approach to limb salvage. J Surg 1988;8:434.Google Scholar
  68. 68.
    Harrington EB, Harrington ME, Schanzer H, et al. The dorsalis pedis bypass: moderate success in difficult situations. J Vasc Surg 1992;15:409.PubMedCrossRefGoogle Scholar
  69. 69.
    Schneider JR, Walsh DB, McDaniel MD, et al. Pedal bypass versus tibial bypass with autogenous vein: a comparison of outcome and hemodynamic results. J Vasc Surg 1993; 17: 1029.PubMedCrossRefGoogle Scholar
  70. 70.
    O’Mara CS, Rinn WR, Johnson ND, et al. Recognition and surgical management of patent but hemodynamically failed arterial grafts. Ann Surg 1981;193:467.PubMedCrossRefGoogle Scholar
  71. 71.
    Veith FJ, Weiser RK, Gupta SK, et al. Diagnosis and management of failing lower extremity arterial reconstructions. J Cardiovasc Surg 1984;25:381.Google Scholar
  72. 72.
    Sanchez L, Gupta SK, Veith FJ, et al. A ten-year experience with one hundred fifty failing or threatened vein and polytetrafluoroethylene arterial bypass grafts. J Surg 1991; 14:729.Google Scholar
  73. 73.
    Sanchez LA, Suggs WD, Veith FJ, et al. Is surveillance to detect failing polytetrafluoroethylene bypasses worthwhile? Twelve-year experience with ninety-one grafts. J Vasc Surg 1993;18:981.PubMedCrossRefGoogle Scholar
  74. 74.
    Bandyk DF, Bergamini TM, Towne JB, et al. Durability of vein graft revision: the outcome of secondary procedures. J Vasc Surg 1991;13:200.PubMedCrossRefGoogle Scholar
  75. 75.
    . Abou-Zamzam AM Jr, Lee RW, Moneta GL, Taylor LM, Porter JM. Functional outcome after infrainguinal bypass for limb salvage. J Vasc Surg 1997;25:287–297.PubMedCrossRefGoogle Scholar
  76. 76.
    Gupta SK, Veith FJ, Ascer E, et al. Cost factors in limb-threatening ischemia due to infraingual arteriosclerosis. Eur J Vasc Surg 1988;2:151.PubMedCrossRefGoogle Scholar
  77. 77.
    . Gupta SK, Veith FJ. Inadequacy of diagnosis related group (DRG) reimbursements for limb salvage lower extremity arterial reconstructions. J Vasc Surg 1990;11: 348.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • William D. Suggs
  • Frank J. Veith
  • Luis A. Sanchez

There are no affiliations available

Personalised recommendations