Abstract

AIM: The morbidity of the patients who treated endovascular for iliac artery and then surgical treatment for its distal lesions was improved by hybrid approach. MEIHODS: 115 patients (110 male(95.7%)-5 female(4.3%)) operated between October 2001-January 2007. Thirtythree (28.7%) of 115 patients treated with iliac artery Percutan Transluminal Angioplasty (PTA)-stent and femoro-popliteal artery or femoro-posterior tibialis artery by-pass was made 15-30 days later respectively. All patients underwent to aortafemoropopliteal and/or cardiac angiography. PTA-stent desicions has made with experienced interventional radiologists for TASC A and B iliac lesions. Surgical treatment was applied TASC C and D iliac lesions. Clopidogrel tablet 75mg/daily treatment ceased 5 days before from surgery and low weight molecular heparin(LWMH) was continued. Patient follow-up was made with physical examination, doppler US and MR angiography postoperatively. RESULTS: Mean age was 60 (36-81). During the by-pass procedure proximal blood flow was perfect and at the end of the operation anterior and posterior tibialis artery pulsations was palpable. The patients who treated by hybrid therapy and their vascular grafts are listed respectively; 6mm (4-23%) or 8mm (14-77%) Polytetra fluroethilen (PTFE) vascular graft in the above-knee by-passes (1 8-54.6%). Saphenous vein (1-3.3%) and heparin-bounded PTFE vascular graft (9-96.7%) in the below knee by-passes (10-30.3%). Saphenous vein(4-93.4%) and heparin-bounded PTFE vascular graft(l)(6.6%) in the Femoro-posterior tibial by-passes(5-15.2%). Nobody had early graft thrombosis. Late graft thrombosis was seen in 3(9%) patients. All patients healed with distal embolectomy without proximal embolectomy. Because of proximal flow was perfect stent restenosis was not observed.Medical treatment of graft thrombosis patients was continued warfarin. Nobody had amputation or mortality. Late infection was seen in only 1 (3.03%) patient. CONLUSIONS: Life comfort increased by hybrid approach for iliac artery and its distal lesions, instead of a major vascular surgery operation smaller intervention was applied.