IP001. Aortoiliac Endarterectomy: A Modern Series

Abstract

Aortoiliac endarterectomy (AIE) was historically the treatment of choice for aortoiliac occlusive disease. The advent of prosthetic grafts and endovascular interventions has lead to a dramatic decrease in the number of AIE being performed. Our goal was to analyze a modern series to determine the safety and efficacy of AIE in select patients. A retrospective review of all patients that underwent AIE from 2006 to 2018 was performed at our institution. Our primary end point was functional patency rate at last follow-up. Secondary end points included 30-day mortality, 30-day complication rates, late postoperative complications, and long-term survival. Summary statistics and survival rates were calculate using the frequency, means and lifetest procedures with the SAS/STAT software version 9.4 (SAS Institute Inc., Cary, NC). A total of 12 AIE procedures were identified. The indications were lifestyle-limiting claudication (75%, 9/12) and critical limb ischemia (25%, 3/12). The majority of patients (75%) were female. Mean age was 51.5 years and average body mass index was 26.7 kg/m2. Ten patients (83%) were active smokers. Preoperative studies included interventional angiography (58%) and computed tomography angiogram (42%). The extent of aortoiliac occlusive disease reached the left external iliac artery in one patient, and it was limited to the infrarenal aorta and common iliacs in the remainder. Two patients had existing infrainguinal disease. Mean follow-up was 49 months (range, 3-139 months). Over the follow-up period, functional primary patency rate was 11 of 12 (92%). One patient was noted to have unilateral common iliac artery thrombosis at 8 months; patency was restored with thrombolysis. Postoperative 30-day survival was 100%. One intraoperative complication of distal embolization occurred that required an immediate embolectomy for revascularization. Other complications included one subarachnoid hemorrhage and one pulmonary embolism. One patient presented with progression of distal lower extremity arterial disease 9 months later requiring secondary intervention. It was noted that the three patients who suffered subsequent lower extremity ischemic events had been acute presentations initially and were active smokers. Existing infrainguinal disease was present in only one of the three patients who had lower extremity ischemic complications. Limb salvage rate was 100% and overall survival rate was 11 of 12 (92%) over the 49-month mean follow-up period. Our results indicate that AIE continues to be a successful and durable option for revascularization in select patients. AIE performed in an acute setting is associated with more complications, but overall survival is not affected.