Is proximal reconstruction alone adequate treatment for combined aortoiliac and femoropopliteal disease?

The results of aortoiliac reconstruction in 91 patients who had aortoiliac atherosclerosis with coincident occlusion of the ipsilateral superficial femoral artery were studied to find out whether proximal reconstruction alone was adequate treatment for combined aortoiliac and femoropopliteal disease. In 5 of the 127 limbs reconstruction was by iliac repair by aortofemoral bypass grafting combined with anastomosis to the common femoral artery (45 limbs), with patch graft angioplasty at the origin of the deep femoral artery (34 limbs) or with extended profundaplasty (26 limbs). In 17 limbs femoropopliteal bypass grafting was performed simultaneously with the proximal reconstruction. In the extended profundaplasty and femoropopliteal groups there was a higher frequency of preoperative rest pain and gangrene, while preoperative ankle to arm systolic pressure ratios were significantly lower (P<0.001, unpaired Student's t-test) in those who underwent femoropopliteal bypass grafting. Postoperatively, the mortality and number of amputations required was higher in patients who underwent extended profundaplasty and femoropopliteal bypass. Reoperation for graft failure was more frequent in the femoropopliteal group but when the graft remained patent, more patients were asymptomatic. The authors conclude that most patients with combined aortoiliac and femoropopliteal disease can be treated by a proximal reconstruction alone, but those with a low ankle to arm systolic pressure ratio are best treated by simultaneous femoropopliteal bypass grafting.