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Long-term results after open and semiclosed thrombendarterectomy for aortoiliac occlusive disease
D Oertli1, P Wigger, J Landmann
1Department of Surgery, Vascular Surgery Unit, University Hospital Basel, Switzerland.
Insights
Long-term results of aortoiliac thrombendarterectomy (TEA) show high patency rates, especially with open TEA. This procedure offers satisfactory outcomes for aortoiliac occlusive disease with low mortality.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Outcomes Research
Background:
- Aortoiliac occlusive disease (AIOD) significantly impacts patient quality of life and limb viability.
- Thrombendarterectomy (TEA) is a surgical option for AIOD, but long-term efficacy requires evaluation.
Purpose of the Study:
- To review the long-term results and patency rates of aortoiliac thrombendarterectomies (TEA).
- To identify prognostic factors influencing the long-term success of TEA for AIOD.
Main Methods:
- A prospective study involving 514 patients undergoing aortoiliac TEA at a Swiss university hospital.
- Continuous and complete follow-up exceeding 15 years for 97.1% of patients.
- Comparison of outcomes between open and semiclosed TEA techniques.
Main Results:
- Overall 15-year patency rates were 84.2%, with open TEA showing significantly higher patency (92.3%) than semiclosed TEA (79.5%) at 15 years.
- Anatomic localization, preoperative disease stage, and gender were significant prognostic factors for patency.
- Hospital mortality was 1.2%, with low rates of early obstruction (2.2%) and reoperations (1.2%).
Conclusions:
- Both open and semiclosed TEA provide highly satisfactory long-term results for AIOD.
- The study demonstrates a low morbidity and mortality associated with these TEA procedures.
- Long-term patency favors open TEA, though both methods yield durable outcomes.
Objectives:
This study reviews the long-term results of 514 aortoiliac thrombendarterectomies (TEA's).
Design:
A prospective study in a major university hospital in Switzerland.
Subjects:
353 male and 62 female patients with aortoiliac occlusive disease. Operative indications: disabling claudication (n=334), rest pain (n=44), and gangrene (n=37).
Methods:
Open and semiclosed TEA's were performed on 167 and 347 limbs, respectively. Follow-up was continuous and complete in 97.1 % of patients over a period of more than 15 years.
Results:
The overall life-table patency rate at 5, 10, and 15 years postoperatively were 93.4 %, 90.4 %, and 84.2 %, respectively. Fifteen years postoperatively, the patency rate of 92.3 % after open TEA was significantly higher (p<0.04) than after semiclosed TEA (79.5 %). However, similar patency rates of 69.5 % and 69.8 % were observed 20 years postoperatively. Further significant prognostic factors on patency were: anatomic localization (p<0.004), preoperative stage of arterial occlusive disease (p<0.008), and gender (p<0.007). Patient's age did not influence the outcome in terms of patency. Hospital mortality rate was 1.2 %. Early obstruction occurred in 2.2 %, leading to subsequent early amputation of 1.4 % and reoperations in 1.2 %. The long-term actuarial survival rates of the patients were 55 %, 36 %, and 18 % after 10, 15, and 20 years postoperatively.
Conclusion:
Both open and semiclosed TEA give highly satisfactory long term results in aortoiliac occlusive disease with a low morbidity and low mortality.