Endarterectomy for occlusive disease of the aortoiliac and common femoral arteries: Evaluation of results of the eversion technic endarterectomy

Abstract

A series of ninety-seven patients with aortoiliac femoral atherosclerotic occlusive disease treated by endarterectomy is reported. The report concerns an evaluation of the eversion technic of endarterectomy specifically adapted to the diffuse disease of the external iliac and common femoral segment. From a total of 194 possible limbs, 151 limbs were treated, with resultant postoperative complications of acute thrombosis (one patient), acute hemorrhage (one patient), and sigmoid necrosis (one patient). There were five postoperative deaths, a mortality of 5.1 per cent. Ninety-two patients who were discharged with patent arterial reconstructions were followed from six months to nine years. The mean follow-up period was forty-nine months. One hundred forty-three limbs were at risk during this period with an accumulative patency rate of 93.3 per cent. There were four instances of reocclusion in the external iliac artery and one of stenosis in the common femoral artery, again emphasizing that the external iliac artery is still the limiting factor and the weakest link in endarterectomy revascularization. Coexistent femoropopliteal disease does not seem to influence the outcome of the proximal iliofemoral endarterectomy in the immediate postoperative period or in the long-term results. Outflow is dependent entirely upon the adequacy of the profunda femoris artery. There were twenty late deaths, a mortality rate of 21.7 per cent. Sixteen deaths were attributed to the finalities of arteriosclerosis. Causes of failure relating to endarterectomy of the external iliac and common femoral arteries are well known. The eversion endarterectomy specifically corrects the technical difficulties and shortcomings in dealing with this segment, thus minimizing the incidence of acute postoperative thrombosis. It is believed that the major benefit of this technic is the dilatation of the remaining adventitial layer, which contributes to the longevity of patency. The concept of segmental occlusive disease treatable by endarterectomy is applicable to diffuse aortoiliac femoral atherosclerosis with all the benefits of autogenous tissue surgery.