Abstract
Combined aortoiliac and femoropopliteal occlusive arterial disease is the most common pattern of atherosclerosis in patients requiring inflow proce dures for ischemic symptoms in the lower extremities. Although most of these patients will be improved by aortobifemoral bypass grafting, subsequent femoropopliteal or distal bypass is often required to save the limb or to relieve rest pain or claudication. Numerous preoperative, noninvasive criteria and derived indices have been used to predict the success of inflow procedures in combined segment disease. Some are partially successful, but none have proved to be adequately sensitive or specific.
Because of the inability to foretell which patients with aortoiliac and femoropopliteal occlusive disease will need a "downstream" repair following an inflow procedure, and because of the difficulty and occasional hazards of secondary groin dissection for arterial operations, one of us (IG) has developed a technique of aortofemoral reconstruction that greatly facilitates subsequent femoropopliteal bypass in patients with combined segment disease.
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