Ileofemoral thromboendarterectomy through retroperitoneal approach

Seven years' experience with retroperitoneal thromboendarterectomy for ileofemoral obstruction has been reviewed. Eighty-five limbs in 75 patients were operated upon. Thirty-four limbs received simultaneous femoropopliteal bypass graft. Operative mortality (3.5%) and morbidity rates were low. The average postoperative hospital stay was 11 days. Only four ileofemoral segments thrombosed for cumulative 1-month and 5-year patency rates of 98.8% and 93.8%, respectively. In addition two femoropopliteal grafts became occluded, leaving, however, the proximal reconstructions patent. The safety, effectiveness, and smooth postoperative course of this operation in both good risk and poor risk patients suggest that it is a most satisfactory alternative to other reconstructive procedures. It is well suited for the treatment of both unilateral and-as a staged operation-bilateral ileofemoral occlusions, and it can ideally be combined with a femoropopliteal bypass. Advantages compared to conventional transabdominal operations and extra-anatomic bypass grafts are discussed.