Combined semiclosed iliac endarterectomy and distal arterial reconstruction for multilevel arterial disease.

Abstract

Semiclosed iliac endarterectomy in combination with an infrainguinal vascular reconstruction has been used over the past decade in the treatment of lower-limb ischaemia. Although the early results of this combination of operations were known, the durability of the external iliac endarterectomy had not been assessed and so an effort was made to review all surviving patients by duplex scanning. Between 1985 and 1993, 48 patients (51 limbs) underwent combined semiclosed iliac endarterectomy and infrainguinal vascular reconstruction for iliac and femoropopliteal occlusive disease. Some 49% of operations were performed for limb salvage. An iliofemoral bypass graft was required twice because of failure of the endarterectomy. A variety of distal arterial reconstructions was employed. One patient required a major amputation and there were two deaths. Mean (s.d.) ankle/brachial indices (ABI) rose from 0.54 (0.14) to 0.85 (0.25) after surgery. Some 85% of the patients who underwent operation for claudication became symptom free; 83% of patients who underwent operation for limb-threatening ischaemia became symptom free or improved to mild claudication during an average of 29 months follow-up. During the follow-up period five patients underwent a further procedure because of restenoses of the external iliac artery. A duplex scanning study was performed in 22 of the 51 limbs an average of 36 months after surgery. External iliac artery stenotic lesions were found in the area of the endarterectomy in three patients. Endarterectomy of the external iliac artery from the groin is an alternative for some patients with iliac arterial disease. In a patient scheduled for an infrainguinal bypass, when an unexpectedly greater degree of athermoma is found at operation in the common femoral and external iliac arteries, this operation may be performed. The durability of the operation as assessed by follow-up duplex scan is quite acceptable.