Radiological intervention to the iliac segments for patients with claudication and coexistent significant infrainguinal disease

Background: The policy with regard to patients with lifestyle‐limiting intermittent claudication is to investigate with duplex ultrasonography and then to treat suitable lesions in the aortoiliac system with balloon angioplasty with or without stenting. In those with coexistent infrainguinal disease, further management is conservative. The aim of this study was to assess the outcome of iliac intervention in this group of patients. Methods: Over 30 months 600 patients with intermittent claudication were assessed; 110 subsequently underwent balloon angioplasty (87 aortoiliac and 23 infrainguinal). Of those undergoing aortoiliac angioplasty 47 also had significant infrainguinal disease. These 47 had a median claudication distance of 80 m and median maximum walking distance 180 m. They underwent angioplasty of 61 arterial segments (one aorta, 32 common iliac, 28 external iliac), with 11 stents deployed in eight patients. There were no immediate complications and a technically satisfactory result was obtained in all but one patient. All patients were reassessed at 6 weeks. Results: The Table gives the findings at 6 weeks.No change Improved (20–99%) Improved (≥ 100%)Claudication distance (m) 5 (11) 9 (19) 33 (70) Maximum walking distance (m) 9 (19) 19 (40) 19 (40)Values are median with percentages in parenthesesFifteen patients (32 per cent) had a pain‐free walking distance greater than 450 m and a further two were limited by angina rather than claudication. Overall the 47 patients had a median claudication distance of 270 m and median maximum walking distance of 420 m. Conclusion: Even in the presence of significant infrainguinal disease, angioplasty in the aortoiliac segments at least doubles the claudication distance in 70 per cent of patients, and appears to be safe. Radiological intervention in these patients is worthwhile. © 2001 British Journal of Surgery Society Ltd