Simultaneous operative repair of multilevel lower extremity occlusive disease

Ronald L. Dalman, Lloyd M. Taylor, Gregory (Greg) Moneta, Richard A. Yeager, John M. Porter

    Research output: Contribution to journalArticle

    38 Citations (Scopus)

    Abstract

    Sixty-two patients (39 men (63%), 23 women (27%), mean age 68 years) with multilevel lower extremity arterial occlusive disease underwent simultaneous inflow and outflow operative arterial repair consisting of aortofemoral bypass in 22 (35%), axillofemoral bypass in 17 (28%), femorofemoral bypass in 15 (24%), iliac endarterectomy in 7 (11%), and unilateral aortoiliac bypass in 1 (2%), combined with 69 outflow procedures (unilateral in 55 patients, 89%), including above-knee femoropopliteal in 12 (17%), below-knee femoropopliteal in 35 (51%), femoroinfrapopliteal in 20 (29%), popliteal tibial in 1 (1%), and femoropedal bypass in 1 (1%). Multiple criteria were used to identify patients with multilevel disease likely to benefit from multilevel procedures. The operations were performed by two operating teams in a median time of 240 minutes. Prosthetic grafts were used for eight (13%) distal bypasses, the remainder were autogenous vein. There was one operative death (1.8%). The mortality rate, morbidity rate, and operative time were not significantly different from a group of patients who underwent concurrent, isolated inflow operations (aortofemoral, axillobifemoral, femorofemoral bypass or iliac endarterectomy). Mean follow-up was 14.9 months (range, 0 to 120). The life-table primary patency for the inflow procedures was 92.6% at 24 months, the outflow was 94.9% at 24 months. Cumulative limb salvage was 90.9% at 48-month follow-up. All patients with claudication were relieved of their symptoms. We conclude that complete correction of multilevel disease can be accomplished with operative time, morbidity rate, and patency equal to that of single level repair. Multilevel procedures provide complete relief of symptoms in a higher percentage of patients than has been reported after single level repair.

    Original languageEnglish (US)
    Pages (from-to)211-221
    Number of pages11
    JournalJournal of Vascular Surgery
    Volume13
    Issue number2
    DOIs
    StatePublished - 1991

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    Lower Extremity
    Endarterectomy
    Operative Time
    Knee
    Morbidity
    Arterial Occlusive Diseases
    Limb Salvage
    Life Tables
    Veins
    Transplants
    Mortality

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Surgery

    Cite this

    Simultaneous operative repair of multilevel lower extremity occlusive disease. / Dalman, Ronald L.; Taylor, Lloyd M.; Moneta, Gregory (Greg); Yeager, Richard A.; Porter, John M.

    In: Journal of Vascular Surgery, Vol. 13, No. 2, 1991, p. 211-221.

    Research output: Contribution to journalArticle

    Dalman, Ronald L. ; Taylor, Lloyd M. ; Moneta, Gregory (Greg) ; Yeager, Richard A. ; Porter, John M. / Simultaneous operative repair of multilevel lower extremity occlusive disease. In: Journal of Vascular Surgery. 1991 ; Vol. 13, No. 2. pp. 211-221.
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    abstract = "Sixty-two patients (39 men (63{\%}), 23 women (27{\%}), mean age 68 years) with multilevel lower extremity arterial occlusive disease underwent simultaneous inflow and outflow operative arterial repair consisting of aortofemoral bypass in 22 (35{\%}), axillofemoral bypass in 17 (28{\%}), femorofemoral bypass in 15 (24{\%}), iliac endarterectomy in 7 (11{\%}), and unilateral aortoiliac bypass in 1 (2{\%}), combined with 69 outflow procedures (unilateral in 55 patients, 89{\%}), including above-knee femoropopliteal in 12 (17{\%}), below-knee femoropopliteal in 35 (51{\%}), femoroinfrapopliteal in 20 (29{\%}), popliteal tibial in 1 (1{\%}), and femoropedal bypass in 1 (1{\%}). Multiple criteria were used to identify patients with multilevel disease likely to benefit from multilevel procedures. The operations were performed by two operating teams in a median time of 240 minutes. Prosthetic grafts were used for eight (13{\%}) distal bypasses, the remainder were autogenous vein. There was one operative death (1.8{\%}). The mortality rate, morbidity rate, and operative time were not significantly different from a group of patients who underwent concurrent, isolated inflow operations (aortofemoral, axillobifemoral, femorofemoral bypass or iliac endarterectomy). Mean follow-up was 14.9 months (range, 0 to 120). The life-table primary patency for the inflow procedures was 92.6{\%} at 24 months, the outflow was 94.9{\%} at 24 months. Cumulative limb salvage was 90.9{\%} at 48-month follow-up. All patients with claudication were relieved of their symptoms. We conclude that complete correction of multilevel disease can be accomplished with operative time, morbidity rate, and patency equal to that of single level repair. Multilevel procedures provide complete relief of symptoms in a higher percentage of patients than has been reported after single level repair.",
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