Review of Direct Anatomical Open Surgical Management of Atherosclerotic Aorto-Iliac Occlusive Disease

Abstract

Aorto-iliac endarterectomy was associated with significantly lower peri-operative morbidity and mortality rates compared with bypass grafting. All three techniques were equally effective in terms of long-term patency.

Eversion endarterectomy of the external iliac artery

“…The primary patency after 5 years is reported at 80-90%, the secondary one at 88-96% [10,11,13,15]. Also longterm observa tions can be found where cumulative patency 10 years after the surgery reaches even 85-89% [12,18].…”

“…The authors report that 10 year after the surgery, the primary patency after endarterectomy was 89.2% and after bypass -78.0%. Very interesting information regarding endarterectomy can be found in the paper from 2010 by Chiu et al -a retrospective analysis of various surgical methods of treatment of atherosclerotic aortoiliac disease [13]. In the summary this retrospec tive analysis informs that the morbidity rate related to endarterectomy is the smallest in comparison with aortofemoral bypass and iliacfemoral bypass -12.5%, 16% and 18.9%, respectively; (p < 0.05).…”

“…Another advantage of endarterectomy in general, including eversion endarterectomy, is a possibility to maintain better sexual potency, because it allows avoiding preparation of the aortic walls and common iliac arteries. The group of patients who would potentially benefit better from endarterectomy rather than bypass in aortoiliac segment includes the patients with atherosclerotic lesions not extending to common iliac arteries, the male patients who, apart from ischae mia of lower limbs, suffer also from erection disorders and diagnosed atherosclerotic stenosis or occlusion of an internal iliac artery, the patients with atherosclerotic occlusion of external iliac arteries with considerable risk of infections after bypass procedures or for whom, due to their narrow blood vessels, bypass is technically difficult, the patients with "localized" atherosclerotic lesions, and last but not least, the patients with bifur cated graft with endtoside anastomosis who need to have the prosthesis removed due to infection -in such cases the authors of this paper suggest endarterectomy as one of the alternative "rescue" solutions [10][11][12][13][14][15][16][17]. Currently, the value of direct aortoiliac endarterecto my has been reminded by Connoly and Price [12], and yet, they raise a question in the title of their paperwhether aortoiliac endarterectomy is a lost art.…”

SCAI expert consensus statement for aorto‐iliac arterial intervention appropriate use

“…Surgical bypass, which includes aortofemoral bypass (AFB), iliofemoral bypass (IFB), and aorto-iliac endarterectomy (AIE), is effective in improving quality of life and relieving symptoms with acceptable mid-and long-term patency rates [1]. These This article was published online on 28 May 2014.…”

“…operations, however, are associated with significant surgical risk (operative mortality for AFB, IFB, and AIE of 4.1, 2.7, and 2.7%, respectively [1].…”