Patch angioplasty improves post-exercise ABI's and reduces reoperation rates in competitive cyclists

Results from a midterm study of highly competitive cyclists who underwent external iliac artery reconstruction (AR) and inguinal ligament release (LR) were reported today at the 65th Vascular Annual Meeting® presented by the Society for Vascular Surgery® (SVS).

Amani D. Politano, MD, a research resident working under Dr. Kenneth Cherry at the University of Virginia School of Medicine's department of surgery in Charlottesville, Va., said that 25 patients (31 limbs) from a single institution between October 2004 and August 2010 were identified for the procedures. Data were collected from medical records review and telephone interviews. Results were analyzed with Chi-square or independent t-test.
Follow-up averaged 32 months (range 2-74). There were 14 males and 11 females and the average patient age was 44.0±6.5 for a graft and 35.3±1.9 for patch angioplasty. There were 23 unilateral and 4 bilateral AR's, including 25 patch angioplasties for localized disease and 6 interposition grafts for extensive disease. Three patients later underwent contralateral AR.

Contralateral LR was done in 12 patients. Of the 14 limbs initially treated with LR alone, 3 required subsequent AR. Nine limbs were not released; one required AR elsewhere. Patency for AR was 100 percent; the 4 reoperations were for symptom recurrence, 2 post-graft (33 percent, 1 bilaterally) and 2 post-angioplasty (8 percent).
Post-exercise ankle-brachial index (ABI) scores were improved in 72 percent of patients by an average of 20 percent in grafts and 41 percent in patches. Satisfaction data were available in 18 patients: satisfied 11 (0 percent graft, 73 percent patch); unsatisfied 4 (100 percent graft, 7 percent patch). 21 patients are still cycling (81 percent), 10 competitively (38 percent). Two of the 4 reoperated patients were unsatisfied but all are still cycling (one person is riding competitively).

"We found that patch angioplasty yields a low rate of reoperation, high levels of satisfaction, return to competitive activity and improvement in post-exercise ABI's," said Dr. Politano. "Interposition grafting is associated with older patients, more extensive disease, and less satisfying results. Inguinal ligament release alone does not appear to reduce the need for subsequent AR. Both the decision to pursue AR and patient expectations must be tempered by the pattern of disease and the potential for unsatisfactory results."