Paten cy of the intern al carotid artery in cas e of common carotid arter y occlusion is usually maintain ed by a flow of blood from th e external caroti d into the intern al carotid artery. A cas e whe re a reversed flow of blood was established from the cerebral circ ulation into the internal carotid artery and eventua lly into the external carotid artery is pr esent ed. Car eful read ing of the cerebral views of th e standard carotid angiogram allowed detection of a retr ograd e flow into the internal carotid artery. Sur gical exploration confirmed the patency of th e internal carotid art ery ; th e occluded common carotid artery was bypassed by a pro sth esis, which resto re d an antegrade flow into the intern al carotid artery.
Thirty-tw o pati ent s (medi an age: 51 years) und erwent a ortoilia c endartere ctomy betw een 1982 a nd 1990, for disa bling claudi cati on (27), rest pain (3). and tissu e loss (2). Th er e was no post-oper ativ e death a nd morbidity a ffected 6 pati ent s. Five pati ent s showed insuffi cient or suboptima l vas cularisa tion of a limb wh ich ju stified ea rly reoper ati on in four. Follow-up was obta ined in 31 pati ents with a med ia n time of 36 months (6 months to 8 yea rs). Five pati ents expe rience d recurren ce of claudicati on symptoms: tw o received a n ao rtofemoral bypass at 6 a nd 36 months. In th e other pati ents, dist al a rterial occlusive disea se acco unted for recurren ce a lone (2 pat ients) or in as sociation with ao rto iliac involvem ent (l). Techni cal pr oblem s or disputabl e indi cati ons wer e resp onsibl e for post operati ve failur e in 3 cases or ea rly recurr ence of sympto ms in 2. Cumulative pat ency rates of ao rtoiliac enda rte rectomy were 94 and 90 per cent at 2 a nd 5 yea rs , a nd actua rial rat es of clinical improvement wer e 90 a nd 82 per ce nt at 2 a nd 5 yea rs. resp ectively. Aort oilia c enda rte rec tomy pr ovides th e adva ntag es of avoiding foreign mat eri al. Th e success of th is reco nstruction dep ends on str ict crite ria of selectio n a nd surgica l expe rtise. It is indi cat ed for th e relati vely young pati en t with nonectasic disease wh er e atheroscl eros is ha s not att ac ked th e exte rn al iliac arter ies .
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