Principles of operation for combined aortoiliac and femoropopliteal occlusive lesions.

In combined chronic occlusive lesions at the aortoiliac and femoropopliteal level, partial repair of the central vessels in combination with profundaplasty and lumbar sympathectomy represents a more simple and shorter procedure than does the previously preferred total correction of both segments. In a retrospective study of 403 limbs, Stages II, III and IV, the triad procedure results in a cumulative patency rate of 77 versus 39 percent for total repair. In limb salvage operations, Stages III and IV, the corresponding figures for the amputation rate were 8 versus 36 per cent and for reoperation, 7 versus 23 per cent. Prerequisites for this type of repair are an improved technical approach and a critical selection of patients with a receiving segment of the popliteal artery and a sufficient runoff below the knee.