Iliacofemoral Artery Stents Implantation Combine With Artificial Graft Bypass For Treatment Of The Arteriosclerosis Obliteran

Objective:The purpose of this study was to review our experience with iliacofemoral artery stents combined with artificial graft bypass for treatment of the arteriosclerosis obliteran(ASO) disease and evaluate the surgery influence on 48-month clinical outcome.The other is to assess the reliability and efficacy of this treatment in the arteriosclerosis obliteran by comparing short and midterm patentcy rates of different groups.Material and methods:From May 2004 to June 2008,83 consecutive patients (94 limbs) who registered in the Department of Vascular Surgery of Tianjin Union Medicine Center with a clinical diagnosis of arteriosclerosis obliteran,received iliacofemoral artery stents implantation combined with artificial graft bypass.All clinical,perioperative and follow-up data were obtained.We collected data on patient demographics,symptoms,risk factors,as well as pre- and post-procedure angle-brachial index,and operative information through reviewing original hospital and surgeons records.All cases were separately divided into different groups based on the way of combination,the place of stents and the style of artificial graft bypass.The observed results include:(1) Complications rate and clinical symptom improvement in 1-month after surgery;(2) Cumulative patency rate of all the limbs within 48 months;(3) Find if there is significant difference though comparing cumulative patency rate between different groups;(4) Risk factor for cumulative patency failure.Results:The SPSS(version 16.0)package was used to analyze data.(1) There were 22 patients who suffered postoperative complication and the postoperative complication rate was 26.51%within 1 month.Clinical symptom improved in 85 of 94 limbs and the clinical success rate was 90.43%.There was a significant rise of the mean ABI from pre-procedure 0.41±0.14 to post-procedure 0.85±0.16. (2) The 6-month,1-,2-,3-and 4-year cumulative patency rate were 93%,87%,79%,65%and 45%of all the limbs.(3) In the different compare groups:The 1-,2-,3-and 4-year cumulative patency rate were 87%,82%,63%and 42%of the homochronous surgery group vs.87%,77%,67%and 48%of the non-homochronous surgery group,and there was no statistically significant difference between the two groups.The 4-year cumulative patency rates were 61.4%of the femorofemoral arterial bypass group vs.48.7% of the femoral-popliteal arterial bypass group,and there was no statistically significant difference between the two groups.The 4-year cumulative patency times were 39.322 months of the group which implanted stents in CIA/EIA vs.25.914 months of the group which implanted stents in CFA/SFA and there was statistically significant difference between the two groups.(4) Age,diabetes and smoking as the risk factors were associated with cumulative patency failure.Conclusion:(1) Iliacofemoral artery stents implantation combined with artificial graft bypass is feasible;safe and effective to the arteriosclerosis obliteran disease.Its immediate outcome and midterm patency is satisfactory.It will be a conventional treatment to the multi-level arterial occlusive disease.(2) In this series,there was no significant difference of the cumulative patency rate between homochronous surgery group and the non-homochronous surgery group as well as the femorofemoral arterial bypass group and the femoral-popliteal arterial bypass group.But there was significant difference of the cumulative patency rate between the group which implanted stents in CIA/EIA and the group which implanted stents in CFA/SFA.(3) The presence of age,diabetes or smoking as a significant risk factors was identified for the cumulative patency failure.