Combined Angioplasty and Femorofemoral Bypass in the Treatment of Unilateral Iliac Arterial Occlusive Disease

PURPOSE: The purpose of this article is to analyze the results of combined agioplasity and femorofemoral bypass in patients with unilateral iliac arterial occlusive disease. METHOD: During the 11-year period from 1990 to 2000, 44 patients with iliac artery occlusion and a hemodynamically significant contralateral iliac artery stenosis were treated by using a combination of percutaneous transluminal angioplasity (PTA) and femorofemoral bypass (n=18) as well as aortobifemoral bypass (n=12) and iliofemoral bypass (n=14) at Korea university medical center. PTA was performed if the lesions in the donor iliac artery were less than 3 cm in length with no more than one well-localized lesion in either the common or external iliac artery, or both. Stent was deployed for suboptimal PTAs. The femorofemoral bypass was done within 3 to 5 days after PTA or stenting. RESULT: The mean age was 61.2 years. The Indications of femorofemoral bypass were hypertension, ischemic heart disease, chronic obstructive lung disease, old age (>75), cancer, and previous abdominal operation. The complication rate of the combination treatment was lower than that of the others. Primary patency rate at 1 and 3 years were 89%, 78% for aortobifemoral bypass, 83%, 66% for iliofemoral bypass, and 77%, 65% for femorofemoral bypass, respectively. CONCLUSION: The combination of PTA with or without stent deployment and femorofemoral bypass can be a useful option for treating iliac occlusion and contralateral iliac stenosis in patients with severe comorbid illness, advanced age, and intra-abdominal pathology. Angioplasity can allow more widespread use of femorofemoral bypass in these patients.

Changing Trend of the Traumatic Arterial Injuries for the Last 10 Years

PURPOSE: As traffic accidents and invasive vascular procedures are increasing these days so are vascular trauma, either blunt or penetrating. So we investigated the changes of clinical status of vascular trauma for the last 10 years. METHOD: We retrospectively reviewed the medical records of 121 patients who had admitted and operated at Korea University Hospital due to traumatic arterial injuries from 1990 to 1999. We divided those patients by period into two groups; Era 1 (1990~1994) and Era 2 (1995~1999). The former group included 51 patients, the latter 70. Age distribution, causes of injury, location, degrees of injury, amputation rate, mortality rate, and operation methods between these two groups were compared. RESULT: The most common cause of arterial injury was blunt trauma by traffic accident in Era 1, injury by broken glasses in Era 2. Iatrogenic injury cases increased (from 3.9% in Era 1 to 10% in Era 2), and so did industrial injuries. Two groups also show similar distribution of degrees and location of injuries. Amputation rate in cases of vascular trauma of lower extremities correlates with combined fracture in both group (P0.05). Each group presented statistically significant correlation between location of injury and mortality (P<0.05). Abdominal injury was related to high mortality rate (63.2%). CONCLUSION: The latter period (Era 2) showed increased iatrogenic injury rate compared to the former. Amputation rate increased when combined with fracture in both groups, but mortality rate didn't significantly change between these two groups.