References

 1. Kannel WB, The SD, Study F. Cigarettes and the development of intermittent claudication. Geriatrics. 1973;28:61-68.

 2. Mathieson FR, Larsen EE, Wulff M. Some factors influencing the spontaneous course of arterial vascular insufficiency. Acta Chir Scand. 1970;136:303-308.

 3. Joseph AM, Norman SM, Ferry LH, et al. The safety of trans-dermal nicotine as an aid to smoking cessation in patients with cardiac disease. N Eng J Med. 1996;335:1793-1798.

 4. Housley E. Treating claudication in five words. BMJ. 1988;296(6635):1483-1484.

 5. Gardener AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain. JAMA. 1995;274:975-980.

 6. Leng GC, Fowler B, Ernst E. Exercise for intermittent claudication. The Cochrane Database of Systematic Reviews 2000, Issue 2.

 7. Radark K, Deck C. Beta-adrenergic blocker therapy does not worsen intermittent claudication in subjects with peripheral arterial disease. A meta-analysis of randomised control trials. Arch Intern Med. 1991;151:1769-1776.

 8. Kannel WB, McGhee DL. Update on some epidemiological features of intermittent claudication in subjects with peripheral vascular disease. J Am Geriatr Soc. 1985;22:13-18.

 9. Anti-platelet Trialists Collaboration. Collaboration overview of randomised trials on anti-

platelet therapy. 1. Prevention of death, myocardial infarction and stroke by prolonged antiplatelet therapy in various catagories of patients. BMJ. 1994;308:81-106.

10.CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1328-1339.

11.Visseren FL, Eikelboom BC. Oral anticoagulant therapy in patients with peripheral artery disease. Semin Vasc Med. 2003;3(3):339-344.

12.Scandinavian Simvastatin Survival Group Study. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383-1389.

13.Sacks FM, Pfeffer MA, Moyle LA, et al. For the Cholesterol and Recurrent Events Trial Investigators. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med. 1996;335:1001-1009.

14.Cameron HA, Waller PC, Ramsey LE. Drug treatment of intermittent claudication: a critical analysis of the methods and findings of published clinical trials. Br J Clin Pharmacol. 1988;26:569-576.

15.Strandness DE, Dalman RL, Panian S, et al. Effect of cilostazol in patients with intermittent claudication: a randomized, double-blind, placebo-controlled study. Vasc Endovasc Surg. 2002;36(2):83-91.

16.Van der Zaag ES, Legemate DA, Nguyen T, et al. Aortoiliac reconstructive surgery based upon the results of duplex scanning. Eur J Vasc Endovasc Surg. 1998;16:383-389.

17.Catalano C, Fraioli F, Laghi A, et al. Infrarenal aortic and lower-limb arterial disease: diagnostic performance of multi-detector row CT angiography. Radiology. 2004;231:555-563.

18.Nicholson T, Downes M. Contrast nephrotoxicity and iso-osmolar contrast agents: implications of NEPHRIC. Clin Radiol. 2003;58:659-660.

19.Willmann JK, Wildermuth S, Pfammater T, et al. Aorto-iliac and renal arteries: prospective intraindervidual comparison of contrast-enhanced three-dimensional MR angiography and multidetector row CT angiography. Radiology. 2003;226:798-811.

20.Dormandy JA. Management of Peripheral Arterial Disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). Eur J Endovasc Surg. 2000;19(Suppl A): S1–S244.

21.Rutherford RB, Durham JA, Kumpe DA. Endovascular intervention for lower extremity ischaemia. In: Rutherford RB, ed. Vascular Surgery. 4th ed. Philadelphia: WB Saunders; 1995:858-874.

22.Nevelsteen A, Wouters L, Suy R. Aortofemoral Dacron reconstruction for aorto-iliac occlusive disease: a 25 year survey. Eur J Vasc Surg. 1991;5:179-186.

23.McCarthy MJ, Olojugba D, Loftus IM, et al. Lower limb surveillance following autologous vein bypass should be life long. Br J Surg. 1998;85:1369-1372.

24.Greenhalgh RM, Belch JJ, Brown LC, et al. The adjuvant benefit of angioplasty in patients with mild to moderate intermittent claudication (MIMIC) managed by supervised exercise, smoking cessation advice and best medical therapy: results from two randomised trials for stenotic femoropopliteal and aortoiliac arterial disease. Eur J Vas Endovasc Surg. 2008 (Dec);36(6):680-688.

25.Graham R. Case of obstructed aorta. Communicated by Sir G Blane. Medico-Chirurgical Transactions, London, 1814.

26.Leriche R. De la résection du carrefour aortico-iliaque avec double sympathectomie lombaire pour thrombose artéritique la l’aorte: le syndrome de l’oblitération termino-aortique par artérite. La presse médicale, Paris. 1940;48:601-607.

27.Ricco JB. Unilateral iliac artery occlusive disease; a randomised multi-centre trial examining direct revascularisation versus crossover bypass. Ann Vasc Surg. 1992;16:841-852.

28.Smeets L, de Borst GJ, Vries JP, et al. Remote iliac artery endarterectomy: seven year results of a less invesive technique for iliac artery occlusive disease. J Vasc Surg. 2003;38:1297-1304.

29.Loggia M, Javerliat I, DiCentra I, et al. Total laparoscopic bypass for aorto-iliac occlusive lesions: 93 case experience. J Vasc Surg. 2004;40:899-906.

30.Tetteroo E, van der Graff Y, Bosch JL, et al. Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac artery occlusive disease. Lancet. 1998;18:499-505.

31.Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl S):S5-S67. PMID 17223489.

Iliac Stenting and Femorofemoral

Crossover Bypass

Jean-Baptiste Ricco and Olivier Page

A 54-year-old man presents to your clinic complaining of bilateral rest pain of the toes and a past medical history of cramping pain in his calves when he walks. The patient had a 30-pack year smoking history and remains an active smoker. Clinical examination revealed an absent left femoral pulse and a diminished right femoral pulse. Popliteal and pedal pulses were absent on both sides. Bilateral carotid bruits were noted. Palpation of the abdominal aorta was normal. The patient was also moderately breathless on minimal exertion and had a chronic productive cough. The ECG was normal, a chest x-ray showed evidence for chronic obstructive pulmonary disease (COPD). FEV1 was 950 mL not enhanced after inhalation of bronchodilators. The patient was currently taking medications for hypertension and elevated cholesterol.

The patient had a Duplex-scan with measurements of the ABIthat was0.40 onthe right side and of 0.29 on the left. The Duplex showed an occlusion of the left external iliac artery and significant stenoses of the right common and external iliac arteries with occlusion of both superficial femoral arteries. The patient had also mild bilateral carotid artery stenosis.

The duplex scan was followed by digital percutaneous subtraction contrast angiography that showed an occlusion of the left external iliac artery and a significant stenosis of the right common and external iliac arteries. Severe occlusive lesions were also seen in both common femoral arteries (Figs. 18.1–18.3). The superficial femoral artery was occluded on both sides. Significant lesions of the crural arteries were also present (not shown).

J-B. Ricco ( )

Section of Vascular Surgery and Vascular Intervention,

University of Poitiers Medical School, Poitiers, France