Femoropopliteal arterial reconstruction with intraoperative iliac transluminal angioplasty for disabling claudication: results of a combined approach.

Seventeen patients with disabling claudication resulting from multilevel arteriosclerotic disease were treated by combined intraoperative iliac transluminal angioplasty and femoropopliteal arterial reconstruction. Clinical improvement or total relief of ischaemic symptoms was observed in 15 out of 17 patients. Iliac pressure gradients were reduced with balloon dilatation to < 2 mmHg in all cases. The mean (+/- S.D.) resting ankle-brachial systolic pressure index increased from 0.42 +/- 0.14 to 0.87 +/- 0.21. Complications from intraoperative angioplasty were not encountered and no early graft failures were seen. The primary actuarial graft patency at 1, 2 and 5 years was 100, 88 and 67%, respectively. Combined intraoperative iliac transluminal angioplasty and femoropopliteal arterial reconstruction is a useful alternative to conventional surgical revascularisation in the treatment of selected patients with disabling claudication in the presence of multilevel arteriosclerotic disease.