Aortoiliac endarterectomy: a lost art?

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Surgical Innovation

Background:

• Aortoiliac endarterectomy (AIE) was historically standard for aortoiliac occlusive disease (AIOD).
• Aortobifemoral bypass (ABFB) largely replaced AIE due to external iliac artery involvement and prosthetic graft availability.
• AIE has become an underutilized procedure, considered a 'lost art' in vascular surgery.

Purpose of the Study:

• To re-evaluate the efficacy and safety of aorto-common iliac endarterectomy (AIE).
• To identify specific patient subgroups where AIE remains a preferable treatment for aortoiliac occlusive disease.
• To compare long-term outcomes of AIE versus aortobifemoral bypass (ABFB).

Main Methods:

• Retrospective review of 205 patients surviving 10 years after treatment for AIOD.
• Comparison between patients treated with AIE (n=39) and ABFB (n=166).
• Analysis of primary patency, graft complications, and specific patient outcomes (e.g., erectile dysfunction).

Main Results:

• Ten-year primary patency was higher for AIE (89.2%) than for ABFB (78%).
• Graft infection or aneurysmal formation occurred in 0% of AIE cases versus 5% of ABFB cases.
• AIE improved erectile dysfunction in select male patients and was successful in complex cases, including infected graft removal.

Conclusions:

• Aorto-common iliac endarterectomy (AIE) demonstrates excellent long-term results and a favorable safety profile.
• AIE is a viable and often superior alternative to aortobifemoral bypass (ABFB) in carefully selected patients.
• Indications for AIE include localized AIOD, specific patient profiles (e.g., smokers, small vessels), and management of infected bypass grafts.