Extensive Vascular Surgery on Combined Aorto-iliac and Femoro-popliteal Diseases. Indications and Results

Abstract

Significant arteriosclerotic lesions of aortoiliac and femoropopliteal arteries are frequently found. Complete revascularization would seem to be the ideal anatomic and physiological result to relieve the occlusive disease involving the lower extremities. The importance of the profunda femoris artery was emphasized by Morris et al. (12). Since then, many authors have cited the importance of this artery as a collateral vessel for revascularizing ischemic limbs with combined segmental occlusive disease (5, 6, 10, 11, 15). In some patients, proximal revascularization alone will not improve symptoms. In others, an initial good result from proximal revascularization may be followed by sudden or gradual deterioration. Hemodynamic tests have been proved to evaluate or distinguish between aortoiliac and femoropopliteal disease, but no one can demonstrate with certainty which of the patients will need a distal revascularization. Most of the authors have advocated and done staged revascularization (2, 4, 7), and bypass of multiple lesions by one-stage aortofemoropopliteal reconstruction has not been widely practiced, mainly because it was a longer and more formidable procedure with higher mortality and graft failure rates (2, 11). Continued improvements in the care of the patients and the surgical procedures for revascularization has allowed performance of extensive vascular surgery when revascularization of the profunda femoris is not sufficient (8, 14).