Endarterectomy and shunt: alternatives or in tandem?

There is no doubt about the efficacy of endarterectomy in the instance of localized occlusions of the arterial tree. The procedure was first developed in 1946 and has been widely used. However, in the case of extensive, non-localized atheromatus disease of the aorta-iliac and the femoral-popliteal-tibial segments in the leg, the majority of vascular surgeons prefer the application of shunts or prosthetics. Nevertheless, there are proponents of extensive obliteration of the endothelium in these regions. There is also the possibility of combining both techniques. In order to assess the outcomes of the latter technique, we reviewed 567 patients who were operated on for aorta-iliac and for femero-popliteo-tibial disease at Chelyabinsk Centre for Vascular Surgery in Russia from 1987 to 1991. Five hundred forty-one of these suffered from atherosclerosis. The other 26 patients had non-specific inflammation of arterial system. The age distribution was 32 to 78 years; there were 551 men and 16 women. Ischemia in the degree of III to IV (according to the scale established by Fontain) was present in 341 patients. Multi-site occlusions and associated multi-organ disease affected 213 patients. Atheromatous disease was determined by ultrasonography, load tests and angiography.