Changing patterns in aortoiliac reconstruction: A 7-year audit

Abstract

A prospective vascular audit was performed in this hospital between 1988 and 1994. There was a substantial increase in the number of vascular reconstructions (78 in 1988; 141 in 1994). Aortobifemoral grafts for occlusive disease comprised 18 per cent of the operations in 1988 and 0.7 per cent in 1994 (95 per cent confidence interval 0.086-0.259). There was a corresponding increase in the number of extra-anatomic grafts (from 3 to 20.6 per cent). There was a threefold increase in the number of percutaneous angioplasties performed for iliac occlusive lesions (14 in 1988; 41 plus 13 iliac stent procedures in 1994). This had no impact on the total rate of surgical intervention for aortoiliac disease, although it probably aided the shift to extra-anatomic reconstruction by dilatation of the donor side. To investigate whether this change is national, rather than local, graft sales figures were obtained from two vascular graft companies; these confirmed a national trend away from aortobifemoral grafting and provide some evidence to support an increase in extra-anatomic bypass grafting.

Endovascular management of iliac artery occlusions: extending treatment to TransAtlantic Inter-Society Consensus class C and D patients

“…This is mirrored by the decreasing number of aortobifemoral grafts performed over the past decade as more patients undergo endovascular treatment. 3 Iliac PTA/stenting has high rates of patency, and, more importantly, there is a gratifying improvement in functional outcome for the individual patient. 4 The TASC consensus statement in 1999 provided a framework for practitioners to assess the treatment of aor- toiliac and femoral-popliteal lesions in the peripheral vasculature by stratifying lesion length and morphology.…”

The management of severe aortoiliac occlusive disease: Endovascular therapy rivals open reconstruction

“…This has been mirrored by a decreasing number of patients undergoing ABF. 2,3 Treatment of aortoiliac occlusions, defined as TransAtlantic Inter-Society Consensus (TASC) B or higher, 4 remains a more challenging endovascular treatment modality than the treatment of iliac stenoses.…”

Two-year single centre results with covered endovascular reconstruction of aortic bifurcation (CERAB) in the treatment of extensive aorto-iliac occlusive disease

“…[12][13][14] However, iliac artery angioplasty and stenting has demonstrated high patency rate, and over the time, the number of aortobifemoral grafts performed has progressively decrease. 15,16 Over the last decades, endovascular procedures have been widespread performed and the improvement in techniques and materials has led to extend this approach also to the treatment of TASC II C-D lesions. 2 In fact, even though no data from randomized trials are nowadays at disposal, previous reports stated that because endovascular treatment lowers complications rate, shortens the hospitalization time and decreases hospital costs in respect to open surgery, it could be particularly indicated for patients older than 80 years.…”