Iliac Artery Percutaneous Transluminal Angioplasty(PTA) as an Adjuvant for Surgical Treatment of Advanced Infrainguinal Arterial Occlusive Disease

This study was performed to assess percutaneous transluminal angioplasty (PTA) as a surgical adjuvant for the patients who suffer from multiple areas of arterial obstruction including iliac and infrainguinal arteries. We performed PTA of iliac artery in twenty-one patients who suffered from multiple areas of arterial occlusive disease in their lower extremities as a surgical adjuvant. The age range was 49 to 80 years old (mean-73.2 years old). Stenosis of iliac artery was identified in 15 patients and occlusion in 6 patients. All of the patients had concomitant advanced arterial stenosis or occlusion of femoropopliteal artery and/or distal trifurcation. PTA for bilateral iliac arteries was performed for 11 patients and unilateral for 10. Endovascular metallic stents was placed in iliac arteries on account of severe arterial dissection after PTA in 3 patients. Eighteen patients had increased inflow to their lower legs and avertted the necessity of intraabodominal bypass surgery. However, 3 patients still needed aortofemoral bypass due to acute occlusion after PTA in one case and persisted inadequate flow in the other two. The clinical successful rate was 86% (18/21). The following surgical treatments were: Femoro-to-distal arterial bypass in 13. (concomitant treatments following bypass surgery were skin graft in 2, disarticulation of toe in 4 & one patient still needed limited below knee amputation to remove the infected foot), skin grafting in 1, and limited below-knee amputation in 4 patients. The limb salvage rate was 72% (13/18). The 4 year clinical patency rate was 70%. PTA of iliac artery is useful to increase peripheral blood blow as an adjuvant for surgical treatment of infrainguinal arterial occlusive disease.