Endovascular aortoiliac grafts in combination with standard infrainguinal arterial bypasses in the management of limb-threatening ischemia

Preliminary report

Michael L. Marin, Frank J. Veith, Luis A. Sanchez, Jacob Cynamon, William D. Suggs, Michael L. Schwartz, Richard E. Parsons, Curtis W. Bakal, Ross T. Lyon

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Purpose: Occlusive disease of the aortoiliac segment may lead to limb-threatening ischemia, if coexisting disease is present in the femoral, popliteal, or tibial arteries. The combined treatment of severe aortoiliac and infrainguinal disease with standard techniques may be hazardous or contraindicated in patients with multiple previous reconstructions, severe comorbid medical illnesses, or both. This report summarizes the technical feasibility and early results of aortoiliac endovascular stented grafts (ESGs) in combination with conventional surgical reconstructions for the treatment of multilevel arterial occlusive disease. Methods: Seventeen patients with multilevel aortoiliofemoral limb-threatening occlusive disease had an ESG inserted to treat long-segment occlusive disease followed by a conventional surgical bypass. ESGs originated from the aortoiliac junction (seven) or the common iliac artery (10) and were inserted into the common femoral (nine), superficial femoral (four), or deep femoral (four) artery. ESG lengths ranged from 16 to 30 cm (mean, 21 cm). Conventional surgical bypasses were constructed from polytetrafluoroethylene (15) or saphenous vein (two) and extended to the popliteal (12), tibial (two), or contralateral femoral (three) arteries. Results: Technical success in graft insertion was achieved in 17 (94%) of 18 attempted ESG procedures. The 1-year primary and secondary cumulative patency rates for ESGs were 94% ± 10% and 100%, respectively, whereas the 1- and 2-year patency rates for the extravascular grafts were 92% ± 10% and 100%, respectively. Four patients had minor postprocedure complications (23%), and no deaths occurred. One patient lost his limb at 16 months because of severe pedal sepsis. Conclusions: Transluminally placed stented grafts in combination with conventional surgical infrainguinal bypasses are a technically feasible and potentially safe option for the treatment of limb-threatening aortoiliofemoral occlusive disease and have demonstrated encouraging early patency. Long-term follow-up will be necessary before widespread application of this technique is advocated. (J VASC SURG 1995;22:316-25.).

Original languageEnglish (US)
Pages (from-to)316-325
Number of pages10
JournalJournal of Vascular Surgery
Volume22
Issue number3
DOIs
StatePublished - 1995
Externally publishedYes

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Ischemia
Extremities
Transplants
Femoral Artery
Thigh
Tibial Arteries
Popliteal Artery
Arterial Occlusive Diseases
Iliac Artery
Saphenous Vein
Polytetrafluoroethylene
Foot
Sepsis
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Endovascular aortoiliac grafts in combination with standard infrainguinal arterial bypasses in the management of limb-threatening ischemia : Preliminary report. / Marin, Michael L.; Veith, Frank J.; Sanchez, Luis A.; Cynamon, Jacob; Suggs, William D.; Schwartz, Michael L.; Parsons, Richard E.; Bakal, Curtis W.; Lyon, Ross T.

In: Journal of Vascular Surgery, Vol. 22, No. 3, 1995, p. 316-325.

Research output: Contribution to journalArticle

Marin, Michael L. ; Veith, Frank J. ; Sanchez, Luis A. ; Cynamon, Jacob ; Suggs, William D. ; Schwartz, Michael L. ; Parsons, Richard E. ; Bakal, Curtis W. ; Lyon, Ross T. / Endovascular aortoiliac grafts in combination with standard infrainguinal arterial bypasses in the management of limb-threatening ischemia : Preliminary report. In: Journal of Vascular Surgery. 1995 ; Vol. 22, No. 3. pp. 316-325.
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abstract = "Purpose: Occlusive disease of the aortoiliac segment may lead to limb-threatening ischemia, if coexisting disease is present in the femoral, popliteal, or tibial arteries. The combined treatment of severe aortoiliac and infrainguinal disease with standard techniques may be hazardous or contraindicated in patients with multiple previous reconstructions, severe comorbid medical illnesses, or both. This report summarizes the technical feasibility and early results of aortoiliac endovascular stented grafts (ESGs) in combination with conventional surgical reconstructions for the treatment of multilevel arterial occlusive disease. Methods: Seventeen patients with multilevel aortoiliofemoral limb-threatening occlusive disease had an ESG inserted to treat long-segment occlusive disease followed by a conventional surgical bypass. ESGs originated from the aortoiliac junction (seven) or the common iliac artery (10) and were inserted into the common femoral (nine), superficial femoral (four), or deep femoral (four) artery. ESG lengths ranged from 16 to 30 cm (mean, 21 cm). Conventional surgical bypasses were constructed from polytetrafluoroethylene (15) or saphenous vein (two) and extended to the popliteal (12), tibial (two), or contralateral femoral (three) arteries. Results: Technical success in graft insertion was achieved in 17 (94{\%}) of 18 attempted ESG procedures. The 1-year primary and secondary cumulative patency rates for ESGs were 94{\%} ± 10{\%} and 100{\%}, respectively, whereas the 1- and 2-year patency rates for the extravascular grafts were 92{\%} ± 10{\%} and 100{\%}, respectively. Four patients had minor postprocedure complications (23{\%}), and no deaths occurred. One patient lost his limb at 16 months because of severe pedal sepsis. Conclusions: Transluminally placed stented grafts in combination with conventional surgical infrainguinal bypasses are a technically feasible and potentially safe option for the treatment of limb-threatening aortoiliofemoral occlusive disease and have demonstrated encouraging early patency. Long-term follow-up will be necessary before widespread application of this technique is advocated. (J VASC SURG 1995;22:316-25.).",
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T1 - Endovascular aortoiliac grafts in combination with standard infrainguinal arterial bypasses in the management of limb-threatening ischemia

T2 - Preliminary report

AU - Marin, Michael L.

AU - Veith, Frank J.

AU - Sanchez, Luis A.

AU - Cynamon, Jacob

AU - Suggs, William D.

AU - Schwartz, Michael L.

AU - Parsons, Richard E.

AU - Bakal, Curtis W.

AU - Lyon, Ross T.

PY - 1995

Y1 - 1995

N2 - Purpose: Occlusive disease of the aortoiliac segment may lead to limb-threatening ischemia, if coexisting disease is present in the femoral, popliteal, or tibial arteries. The combined treatment of severe aortoiliac and infrainguinal disease with standard techniques may be hazardous or contraindicated in patients with multiple previous reconstructions, severe comorbid medical illnesses, or both. This report summarizes the technical feasibility and early results of aortoiliac endovascular stented grafts (ESGs) in combination with conventional surgical reconstructions for the treatment of multilevel arterial occlusive disease. Methods: Seventeen patients with multilevel aortoiliofemoral limb-threatening occlusive disease had an ESG inserted to treat long-segment occlusive disease followed by a conventional surgical bypass. ESGs originated from the aortoiliac junction (seven) or the common iliac artery (10) and were inserted into the common femoral (nine), superficial femoral (four), or deep femoral (four) artery. ESG lengths ranged from 16 to 30 cm (mean, 21 cm). Conventional surgical bypasses were constructed from polytetrafluoroethylene (15) or saphenous vein (two) and extended to the popliteal (12), tibial (two), or contralateral femoral (three) arteries. Results: Technical success in graft insertion was achieved in 17 (94%) of 18 attempted ESG procedures. The 1-year primary and secondary cumulative patency rates for ESGs were 94% ± 10% and 100%, respectively, whereas the 1- and 2-year patency rates for the extravascular grafts were 92% ± 10% and 100%, respectively. Four patients had minor postprocedure complications (23%), and no deaths occurred. One patient lost his limb at 16 months because of severe pedal sepsis. Conclusions: Transluminally placed stented grafts in combination with conventional surgical infrainguinal bypasses are a technically feasible and potentially safe option for the treatment of limb-threatening aortoiliofemoral occlusive disease and have demonstrated encouraging early patency. Long-term follow-up will be necessary before widespread application of this technique is advocated. (J VASC SURG 1995;22:316-25.).

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