Does donor iliac artery percutaneous transluminal angioplasty or stent placement influence the results of femorofemoral bypass? Analysis of 70 consecutive cases with long-term follow-up - Discussion

Purpose: Femorofemoral bypass procedures are being performed with increasing frequency in some patients with bilateral disease in whom the 'donor' iliac artery undergoes percutaneous transluminal angioplasty or stent placement. This study was undertaken to critically examine the efficacy of this approach. Methods: The records of 70 consecutive patients who over a 14- year period underwent elective femorofemoral bypass procedures for chronic occlusive disease, including those who did (group I; n = 26) and did not (group II; n = 44) undergo donor iliac percutaneous transluminal angioplasty or stent placement, were reviewed. Results: No significant differences were found between group I and II patients with respect to age, gender, risk factors, surgical indications, preoperative ankle-arm indices, and the performance of associated procedures. One patient (1.4%) died of a myocardial infarction; no other major cardiopulmonary complications occurred. The postoperative change in the group I donor limb ankle-brachial index ranged from -0.18 to 0.11 (mean, 0.00), revealing no significant steal. The primary graft patency rates for group I and II patients 30 days after surgery were 92% and 98%, respectively, and at 1, 3, 5, and 7 years after surgery were 87% and 81%, 79% and 73%, 79% and 59%, and 66% and 59%. Conclusions: Donor iliac artery percutaneous transluminal angioplasty or stent placement does not compromise the results of femorofemoral bypass procedures in patients with chronic iliac artery occlusive disease.