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External Iliac Artery As Inflow Source Offers Excellent Patency With Less Pulmonary Complications For Inflow Reconstructions
Casey Hladik, MD, Gabrielle Rieth, MD, Jeffrey C. Hnath, MD, R. Clement Darling, III, MD.
Albany Medical College, Albany, NY, USA.
OBJECTIVES: Iliac artery to femoral artery bypass has been shown to have superior patency when compared to using a femoral artery or axillary as inflow. Higher flow volumes in the common iliac artery (CIA) versus an external iliac artery (EIA) may provide improved patency secondary to larger size and more direct flow from the aorta however there may be issues related to the more extensive operative exposure. The purpose of this study is to compare outcomes of CIA and EIA based inflow bypasses to the femoral artery.
METHODS: A single hospital-based vascular surgery division surgical management system was queried for iliac to femoral artery bypasses from 2017-2021. The CIA and EIA groups’ demographics, indications, operative details, and outcomes were tabulated and compared using standard statistics.
RESULTS: 231 bypasses were identified (40, 17.3% CIA and 191, 82.2% EIA), of which 25/40 (67.5%) CIA bypasses and 131/191 (62.5%) EIA bypasses were performed on males with a mean age 61 years (range 21-93). Demographics including diabetes, hypertension, coronary artery disease, smoking status, COPD, and chronic kidney disease were similar between groups, except for more hyperlipidemia in CIA group (33, 77.5% vs 109, 57.1% p = 0.01). Indications demonstrated more claudicants in CIA group (13, 32.5% vs 22, 11.5% P=.0007). Conduit was mostly PTFE (35, 87.5% CIA vs 170, 89.01% EIA p=.89. Complications were similar except for pulmonary complications in CIA (2, 5% vs 1, 0.5% P = 0.02). Readmission rates (6, 15% vs 23, 12.0% p=0.61) and wound infection rates (3, 7.5% vs 5, 2.6% p=0.12) were similar for CIA and EIA respectively. Perioperative mortality rates were similar for CIA and EIA (2, 5% vs 6, 3.1% P =0.55). Major amputation rates were higher in the CIA group (7, 17.5% vs 13, 6.8% p= .03). Late bypass occlusion rates trended higher in EIA (1, 2.5% vs 10, 5.24% p=.46)
CONCLUSIONS: Iliac artery inflow-based bypasses overall offer excellent results. The common iliac based bypasses may require more exposure and also may be indicative of more widespread atherosclerosis. This series suggests that inflow bypass from the external iliac artery is associated with lower postoperative complication rates and equivalent patency.
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