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

• Published in: Surgery today (Tokyo, Japan) Vol. 47; no. 3; pp. 293 - 300
• Main Authors: Maekawa, Takashi, Komori, Kimihiro, Kodama, Akio, Banno, Hiroshi, Narita, Hiroshi, Sugimoto, Masayuki
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.03.2017
• Subjects: Aged; Aged, 80 and over; Aorta - surgery; Arterial Occlusive Diseases - complications; Arterial Occlusive Diseases - surgery; Cohort Studies; Endovascular Procedures - methods; Female; Femoral Artery - surgery; Humans; Iliac Artery - surgery; Intermittent Claudication - etiology; Intermittent Claudication - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Popliteal Artery - surgery; Retrospective Studies; Risk Factors; Stents; Surgery; Surgical Oncology; Time Factors; Treatment Outcome; Vascular Patency; Peripheral arterial disease; Claudication; Endovascular therapy
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-016-1399-0

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.