[Simultaneous or stepwise procedure in combined minimal invasive and conventional operation methods in vascular...

Long-term results of femoral angioplasty and stenting are not as successful as open surgical procedures. Transfemoral retrograde recanalisation of the iliac vessel by semiclosed endarterectomy is a low-invasive procedure. Certainly the outcome is characterised by a number of early occlusions caused by dissections or remaining intimal flaps. Recent advances in endovascular management of occlusive disease have changed the situation. Intraoperative control of lumen by angioscopy and removal of occlusive material via TV-monitored endoscopic manipulation has induced better results of endarterectomy. In addition to this more effective recanalisation, the proximal intimal step, mostly at the level of the iliac bifurcation, is managed by intraoperative balloon dilatation and stenting. This combined approach has reduced the necessity of reoperation by about 15%. The cumulative 5-year patency rate for this combined procedure is 88%.