[Indications and therapy of obstructive aorto-iliac disease from a surgical viewpoint]

Operative management in patients with aortoiliac disease consists of thrombendarterectomy for unilateral and localised lesions and of aortofemoral/iliac graft implantations for bilateral and extensive lesions. Operative morbidity and mortality depend on the type of anesthesia and are influenced mainly by operating technique. The individual risk of operation depends on the localization of the disease and increases significantly if organ arteries are involved. Therefore, asymptomatic stenosis of the extracranial carotid arteries, renal, and mesenteric arteries have to be recognized, and for significant lesions prophylactical surgical management should be performed. An extensive noninvasive and invasive preoperative diagnostic program will detect asymptomatic stenosis in order to perform prophylactic reconstruction or to exclude those patients from major vascular operations, if the lesion is not accessible. In this particular small group of patients an extraperitoneal approach to the aortic bifurcation or an extra-anatomical bypass like femoro-crossover femoral or iliaco-femoral with revascularization of the profundal femoral artery is recommended. Continuous epidural anesthesia can reduce the risk of operation by reduction of cardial and respiratory complications and, together with the extraperitoneal or extra-anatomical approach the operative trauma is minimized.