Eversion Endarterectomy - An Alternative Approach to Occlusive External Iliac Artery disease
Megan Power Foley1, Thomas M Aherne1, Conor Dooley1
1Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Republic of Ireland.
Insights
Eversion endarterectomy offers a safe and effective treatment for external iliac artery disease, demonstrating durable patency and low complication rates in a retrospective study.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Endovascular intervention is preferred for common iliac artery (CIA) lesions but has limited durability for Trans-Atlantic Inter-Society Consensus (TASC)-II C and D external iliac artery (EIA) disease.
- Aorto-femoral bypass is durable but unsuitable for patients with significant comorbidities.
- Eversion endarterectomy presents an alternative for occlusive EIA disease.
Purpose of the Study:
- To evaluate the safety and effectiveness of eversion endarterectomy for external iliac artery (EIA) disease.
- To assess the durability and outcomes of this surgical technique.
Main Methods:
- A single-center, retrospective review of patients undergoing eversion endarterectomy for EIA disease between 2000 and 2020.
- Data collected included demographics, clinical presentation, operative details, and follow-up information.
- Analysis of technical success, symptomatic improvement, patency rates, limb salvage, and perioperative outcomes.
Main Results:
- Fifty eversion endarterectomies were performed in 47 patients with TASC C and D lesions, primarily for critical limb ischemia.
- Technical success was 100% with 84% immediate symptomatic improvement.
- Five-year primary-assisted patency was 74%, and limb salvage was 96%, with low perioperative morbidity (10%) and mortality (2%).
Conclusions:
- Eversion endarterectomy is a safe and effective alternative for treating occlusive EIA disease.
- The procedure offers durable five-year patency with acceptable perioperative risks.
- It provides a valuable option for patients unsuitable for endovascular therapy or extensive open reconstruction.
Objectives:
While endovascular intervention is the recommended first option for management of common iliac artery (CIA) lesions, it lacks durable patency for Trans-Atlantic Inter-Society Consensus (TASC)-II C and D lesions involving the external iliac artery (EIA). Aorto-femoral bypass is a durable option but is unsuitable in patients with significant co-morbidities. Eversion endarterectomy provides an alternative to both endovascular and extensive open aortoiliac reconstruction for occlusive EIA disease.
Materials And Methods:
A single-center, retrospective review (2000-2020) of all patients undergoing eversion endarterectomy for EIA disease was undertaken. Demographic, clinical, operative and follow-up data were recorded.
Results:
Fifty eversion endarterectomies were performed in 47 patients. The median age was 65.0 years (range 46-82) and 66.6% were male. Sixty-eight percent (n = 34) were ASA grade 3. Indications for intervention were disabling claudication (44%) and critical limb ischaemia (56%). Angiography demonstrated 22 TASC C and 28 TASC D lesions. The median follow-up was 18.5 months (range 0-149). The technical success rate was 100%, and 84% (n = 42) experienced an immediate symptomatic improvement. Primary and primary-assisted patency at one, three and five years was 86%, 82% and 74%, and 100%, 96% and 92%, respectively. The five-year limb salvage rate was 96%. Eight limbs required reintervention to maintain patency, either by open (n = 2), endovascular (n = 3) or hybrid approach (n = 3). Thirty-day mortality was 2% (n = 1) with 10% (n = 5) experiencing a procedure-related morbidity. All-cause mortality was 38% (n = 19) during the follow-up period.
Conclusions:
Eversion endarterectomy is a safe, effective alternative treatment for occlusive EIA disease. This study reports durable patency at five years and low perioperative morbidity and mortality.
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