Remote iliac artery endarterectomy

Seven-year results of a less invasive technique for iliac artery occlusive disease

Smeets, Luuk MD
de Borst, Gerrit-Jan MD
de Vries, Jean-Paul MD, PhD
van den Berg, Jos C. MD, PhD
Ho, Gwan H. MD, PhD
Moll, Frans L. MD, PhD

^aDepartment of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
^bDepartment of Interventional Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
^cDepartment of Vascular Surgery, Amphia Hospital, Breda, The Netherlands

Reprint requests: Frans L. Moll, MD, PhD, Vascular Surgery Department, St Antonius Hospital, Koekoekslaan 1, 3534 CM, Nieuwegein, The Netherlands

Competition of interest: none.

Presented at the 2002 Joint Annual Meeting of The American Association for Vascular Surgery and The Society for Vascular Surgery, Boston, Mass, June 10, 2002.

Submitted Jan 28, 2003; accepted Jun 3, 2003.

Journal of Vascular Surgery 38(6):p 1297-1304, December 2003.

Objective

Remote endarterectomy of external and common iliac artery occlusions through a single, groin incision under fluoroscopic guidance is a relative unknown surgical procedure. This prospective single center cohort study describes this less invasive endovascular technique with the ring strip cutter and its early complications. The results at midterm follow-up are presented.

Patients and methods

From April 1994 to July 2001, 49 remote-endarterectomies of the external or common iliac artery were performed in a retrograde manner from a single, groin incision in 48 patients (30 men, 31 procedures). The median age was 66 years (39 to 82 years). Indications for operation were as follows: severe claudication in 28 (57%), rest pain in 13 (27%), and gangrene in 8 (16%) procedures. Follow-up included clinical evaluation, ankle-brachial index, and duplex scanning at 6 weeks, 3 months, and yearly thereafter.

Results

Intraoperative technical success was achieved in 43 (88%) procedures. A retroperitoneal incision was necessary in three patients for an additional arteriotomy in the iliac artery and in three others for a bypass procedure. The mean follow-up was 20 months (2 to 77 months). Three-year cumulative primary patency rate by means of life table analysis was 60.2% ± 12.0 (SE). During follow-up, percutaneous transluminal balloon angioplasty with and without stenting was performed in six and two patients, respectively, resulting in a 3-year primary-assisted patency rate of 85.7% ± 9.56. Three-year secondary patency was 94.2% ± 5.50.

Conclusions

Remote endarterectomy in external and common iliac arterial occlusive disease is a feasible endovascular procedure with a low complication rate. The midterm primary-assisted patency rate is good.