Surgical treatment of aorto-iliac atherosclerosis

216 limbs in 180 patients were operated upon for aorto-iliac atherosclerosis during the period of 1967 to 1974. 45% were operated on for rest-pain or gangrene, while 55% had intermittent claudication. Four year patency following semi-closed end-arterectomy was 85% whereas 83% and 74% 4 year patencies were observed after open endarterectomy and synthetic by-pass grafting. However, synthetic by-pass grafts were used in patients with the most extensive atherosclerosis. Femoro-femoral and axillo-femoral subcutaneous by-pass grafts may be useful alternatives when contraindication exists against direct reconstruction of the aorta or the iliac arteries. The operative mortality was 6.7%. Eleven patients were reoperated for bleeding and 10 for early reocclusion. A good result was obtained in 14 of these cases. The indications for the different operative techniques are discussed. It is concluded that both prosthetic by-pass grafting and endarterectomy have a definite place in the treatment of aorto-iliac atherosclerosis.