Skip to main content

Advertisement

Log in

The impact of inflow treatment for claudicants with both aortoiliac and femoropopliteal occlusive disease

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

This study evaluated the early and long-term results of the sole use of endovascular treatment in the treatment of inflow lesions in claudicants with both aortoiliac and femoropopliteal (FP) lesions.

Methods

A retrospective study that included 100 limbs in 73 patients was performed. The patency rates of aortoiliac artery stents, the continued clinical improvement rates, the risk factors for persistent disabling claudication after inflow revascularization, and the rates of freedom from additional FP procedures were examined.

Result

After inflow revascularization, almost complete relief from intermittent claudication was seen in 79 % of the limbs, while 21 % of the limbs continued to suffer from disabling claudication. A multivariate analysis showed that a run-off score of ≥7 was an independent predictor for persistent disabling claudication after aortoiliac revascularization [hazard ratio (HR) 5.11, 95 % confidence interval (CI) 1.34–19.45; P = 0.02]. The primary patency rates at 1, 3, 5, and 6 years were 96, 96, 96 and 89 %, respectively. The secondary patency rate at 6 years was 100 %. The continued clinical improvement rates at 1, 3, 5, and 6 years were 81, 78, 78 and 72 %, respectively. The rates of freedom from additional FP procedures at 1, 3, 5, and 6 years were 97, 90, 90, and 90 %, respectively.

Conclusions

Aortoiliac endovascular revascularization is effective treating claudicants with both aortoiliac and femoropopliteal lesions. Furthermore, a run-off score of ≥7 appears to be a potential predictor for persistent disabling claudication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382:1329–40.

    Article  PubMed  Google Scholar 

  2. Feinglass J, McCarthy WJ, Slavensky R, Manheim LM, Martin GJ, The Chicago Claudication Outcomes Research Group. Effect of lower extremity blood pressure on physical functioning in patients who have intermittent claudication. J Vasc Surg. 1996;24:503–12.

    Article  CAS  PubMed  Google Scholar 

  3. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, et al. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine, and Society for Vascular Surgery. J Am Coll Cardiol. 2011;58:2020–45.

    Article  PubMed  Google Scholar 

  4. Society for Vascular Surgery Lower Extremity Guidelines Writing Group, Conte MS, Pomposelli FB, Clair DG, Geraghty PJ, McKinsey JF, Mills JL, et al. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg. 2015;61(3 Suppl):2S–41S.

    Google Scholar 

  5. Vemulapalli S, Dolor RJ, Hasselblad V, Subherwal S, Schmit KM, Heidenfelder BL, et al. Comparative effectiveness of medical therapy, supervised exercise, and revascularization for patients with intermittent claudication: a network meta-analysis. Clin Cardiol. 2015;38(6):378–86.

    Article  PubMed  Google Scholar 

  6. Fakhry F, van de Luijtgaarden KM, Bax L, den Hoed PT, Hunink MG, Rouwet EV, et al. Supervised walking therapy in patients with intermittent claudication. J Vasc Surg. 2012;56:1132–42.

    Article  PubMed  Google Scholar 

  7. Laborde JC, Palmaz JC, Rivera FJ, Encarnacion CE, Picot MC, Dougherty SP. Influence of anatomic distribution of atherosclerosis on the outcome of revascularization with iliac stent placement. J Vasc Intervent Radiol. 1995;6:513–21.

    Article  CAS  Google Scholar 

  8. Timaran CH, Stevens SL, Freeman MB, Goldman MH. External iliac and common iliac artery angioplasty and stenting in men and women. J Vasc Surg. 2001;34:440–6.

    Article  CAS  PubMed  Google Scholar 

  9. Sixt S, Krankenberg H, Möhrle C, Kaspar M, Tübler T, Rastan A, et al. Endovascular treatment for extensive aortoiliac artery reconstruction: a single-center experience based on 1712 interventions. J Endovasc Ther. 2013;20:64–73.

    Article  PubMed  Google Scholar 

  10. Ichihashi S, Higashiura W, Itoh H, Sakaguchi S, Nishimine K, Kichikawa K. Long-term outcomes for systematic primary stent placement in complex iliac artery occlusive disease classified according to Trans-Atlantic Inter-Society Consensus (TASC)-II. J Vasc Surg. 2011;53:992–9.

    Article  PubMed  Google Scholar 

  11. Laird JR, Katzen BT, Scheinert D, Lammer J, Carpenter J, Buchbinder M, et al. Nitinol stent implantation vs. balloon angioplasty for lesions in the superficial femoral and proximal popliteal arteries of patients with claudication: three-year follow-up from the RESILIENT randomized trial. J Endovasc Ther. 2012;19:1–9.

    Article  PubMed  Google Scholar 

  12. Matsumura JS, Yamanouchi D, Goldstein JA, Pollock CW, Bosiers M, Schultz GA, et al. The United States StuDy for EvalUating EndovasculaR TreAtments of Lesions in the Superficial Femoral Artery and Proximal Popliteal By usIng the Protege EverfLex NitInol STent SYstem II (DURABILITY II). J Vasc Surg. 2013;58(73–83):e1. doi:10.1016/j.jvs.2012.12.066.

    Google Scholar 

  13. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26:517–38.

    Article  CAS  PubMed  Google Scholar 

  14. Rowe VL, Lee W, Weaver FA, Etzioni D. Patterns of treatment for peripheral arterial disease in the United States: 1996–2005. J Vasc Surg. 2009;49:910–7.

    Article  PubMed  Google Scholar 

  15. Schillinger M, Minar E. Percutaneous treatment of peripheral artery disease: novel techniques. Circulation. 2012;126:2433–40.

    Article  PubMed  Google Scholar 

  16. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, TASC II Working Group, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45:S5–67.

    Article  PubMed  Google Scholar 

  17. Soga Y, Iida O, Kawasaki D, Yamauchi Y, Suzuki K, Hirano K, et al. Contemporary outcomes after endovascular treatment for aorto-iliac artery disease. Circ J. 2012;76:2697–704.

    Article  PubMed  Google Scholar 

  18. Galaria II, Davies MG. Percutaneous transluminal revascularization for iliac occlusive disease: long-term outcomes in Trans-Atlantic Inter-Society Consensus A and B lesions. Ann Vasc Surg. 2005;19:352–60.

    Article  PubMed  Google Scholar 

  19. Ye W, Liu CW, Ricco JB, Mani K, Zeng R, Jiang J. Early and late outcomes of percutaneous treatment of TransAtlantic Inter-Society Consensus class C and D aorto-iliac lesions. J Vasc Surg. 2011;53:1728–37.

    Article  PubMed  Google Scholar 

  20. Indes JE, Pfaff MJ, Farrokhyar F, Brown H, Hashim P, Cheung K, et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther. 2013;20:443–55.

    Article  PubMed  Google Scholar 

  21. Wolf GL, Wilson SE, Cross AP, Deupree RH, Stason WB. Surgery or balloon angioplasty for peripheral vascular disease: a randomized clinical trial. Principal investigators and their Associates of Veterans Administration Cooperative Study Number 199. J Vasc Interv Radiol. 1993;4(5):639–48.

    Article  CAS  PubMed  Google Scholar 

  22. Bozoglan O, Mese B, Eroglu E, Elveren S, Gul M, Celik A, et al. Which prosthesis is more resistant to vascular graft infection: polytetrafluoroethylene or Omniflow II biosynthetic grafts? Surg Today. 2016;46(3):363–70.

    Article  CAS  PubMed  Google Scholar 

  23. Perkins JM, Collin J, Creasy TS, Fletcher EW, Morris PJ. Exercise training versus angioplasty for stable claudication. Long and medium term results of a prospective, randomised trial. Eur J Vasc Endovasc Surg. 1996;11(4):409–13.

    Article  CAS  PubMed  Google Scholar 

  24. Greenhalgh RM, Belch JJ, Brown LC, Gaines PA, Gao L, Reise JA, et al. The adjuvant benefit of angioplasty in patients with mild to moderate intermittent claudication (MIMIC) managed by supervised exercise, smoking cessation advice and best medical therapy: results from two randomised trials for stenotic femoropopliteal and aortoiliac arterial disease. Eur J Vasc Endovasc Surg. 2008;36(6):680–8.

    Article  CAS  PubMed  Google Scholar 

  25. Morris GC Jr, Edwards E, Cooley DA, Crawford ES, De Bakey ME. Surgical importance of the profunda femoris artery: analysis of 102 cases with combined aortoiliac and femoropopliteal occlusive disease treated by revascularization of deep femoral artery. Arch Surg. 1961;82:32–7.

    Article  PubMed  Google Scholar 

  26. Martin P, Frawley JE, Barabas AP, Rosengarten DS. On the surgery of atherosclerosis of the profunda femoris artery. Surgery. 1972;71:182–9.

    CAS  PubMed  Google Scholar 

  27. McDermott MM, Carroll TJ, Kibbe M, Kramer CM, Liu K, Guralnik JM, et al. Proximal superficial femoral artery occlusion, collateral vessels, and walking performance in peripheral artery disease. JACC Cardiovasc Imaging. 2013;6(6):687–94.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kimihiro Komori.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest in association with this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maekawa, T., Komori, K., Kodama, A. et al. The impact of inflow treatment for claudicants with both aortoiliac and femoropopliteal occlusive disease. Surg Today 47, 293–300 (2017). https://doi.org/10.1007/s00595-016-1399-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-016-1399-0

Keywords

Navigation