Long-term results of prosthetic and non-prosthetic reconstruction for obstructive aorto-iliac disease

In this retrospective study the results of 518 prosthetic aorto-iliac reconstructions (PRS) and of 229 thrombo-endarterectomies (TEA) were evaluated, with inclusion of follow-up results up to 20 years after surgery. Patients in the PRS group had presented with more severe ischaemic symptoms and more extensive arterio-sclerotic obstructions than the patients in the TEA group. Results in the TEA group were further analysed according to the extension of arterio-sclerotic disease: there were 93 patients with obstructions limited to the aorta or common iliac arteries and 136 patients with more extensive lesions. Patients with limited obstructions were younger, proportionally more often female, had fewer risk factors, and presented with less severe ischaemic symptoms than patients with more extensive obstructions. Operative mortality and early technical and functional results were similar in the PRS and TEA group, but long-term survival and patency rates were significantly better, and the need for late, additional operations was less in the TEA group. Late functional success rates were similar in both groups. The differences in outcome were explained by patient selection. Within the TEA group significantly superior results regarding survival, patency, need for late, additional surgery, and functional success were observed in the subset of patients with obstructions limited to the aorta or common iliac arteries. Considering these results and the risks inherent in a prosthetic reconstruction, such as prosthetic infection and the chance for false aneurysms, we advocate the use of an aorto-iliac TEA in properly selected patients.