Management of combined segment disease

Simultaneous Versus Two–Stage Multisegmental Reconstruction for Critical Lower Limb Ischemia

“…12,13,19,31,32 We fully agree with this opinion. But a majority of the patients have multiple risk factors -ischemic heart disease, chronic pulmonary insufficiency, diabetes -and major aortic surgery cannot be recommended.…”

“…In case of critical limb ischemia, many authors 11,13,16,18,[31][32][33][34] indicate the importance of the extent of disease in the deep femoral artery which forms the main collateral network in the presence of superficial femoral artery occlusion. Occlusion of diffuse diseased PFA is one of the most important indications to perform multisegmental reconstruction.…”

“…[11][12][13][17][18][19][20][21][22]36 Dalman et al 20 presents a 90% limb salvage rate at the 36 month follow-up period in his group of 62 patients. It needs to be noted that 20% of patients in this group were operated on for claudication.…”

“…Using an extraperitoneal iliac endarterectomy as an inflow procedure combined with femoropopliteal/tibial bypass, Taylor et al 17 achieved 100% patency of the iliac artery and an 87% outflow patency rate at six years. After femorofemoropopliteal reconstruction, Ellenby et al 13 presented a 40% patency rate of the femoropopliteal segment after five years.…”

“…Proximal or inflow revascularization combined with profundoplasty remains the most accepted way of treatment. [11][12][13] Selection of an optimal inflow procedure for high risk patients is another problem. [14][15][16][17] Surgical correction of several diseased segments is not widely used but promises the best results.…”