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Aortoiliac Endarterectomy Provides A Durable Alternative To Bypass In Women And Patients With Small Native Vessels
SHIVIK K. PATEL1, Sophia Trinh, MD
1, Amanda Tullos, MD
1, Calin Manea, MD
2, Alykhan Lalani, MD
1, Amit Chawla, MD
1, Denise Danos, PhD
1, Claudie Sheahan, MD
1, Malachi Sheahan, MD
1.
1Louisiana State University, New Orleans, LA, USA,
2York Hospital, York, PA, USA.
(Objective)Aortoiliac occlusive disease (AOID) is commonly managed with open bypass or endovascular intervention. These techniques have decreased utilization of aortoiliac endarterectomy (AIE) when treating AOID patterns in modern vascular practice. We retrospectively evaluated our experience with AIE to assess safety and efficacy of AIE in patients with isolated AOID.
(Methods)We identified 25 patients that underwent AIE from 2006-2022. Primary endpoint was patency rate over follow-up. Secondary endpoints: 30-day mortality, overall survival, major adverse limb events (MALE), and aortoiliac vessel diameters.
(Results)Twenty-five AIE procedures. Intervention indications included: lifestyle limiting claudication (72%, 18/25), tissue loss (12%, 3/25), acute limb ischemia (8%, 2/25), and ischemic rest pain (4%, 1/25). Most patients were female (72%, 18/25). Mean vessel diameters were smaller in women. Respectively, mean vessel diameters for female and male patients were: Mid-aortic (10 and 16 mm, p= 0.001), Distal-aortic (9 and 17.5 mm, p= 0.007), Common iliac (5 and 9.1 mm, p= 0.006), and external iliac (4.1 and 7 mm, p= 0.002). One patient had AOID involving an external iliac artery, remainder had disease limited to infrarenal aorta and common iliac arteries. Mean age was 53.6 years. Mean follow-up was 39 months. At 3-years, primary patency 0.86 and secondary patency 0.89 (Fig 1). 30-day survival was 100% and overall survival was 94%. Deaths included pulmonary embolus and subarachnoid hemorrhage. Freedom from MALE at 2- and 3-years was 0.89 and 0.81, respectively (Fig 2). Two patients presenting with acute limb ischemia had early post-operative iliac thrombosis necessitating thrombectomy, one required amputation. Four patients had late iliac occlusion - one requiring thrombolysis with external iliac artery intervention, two were asymptomatic, and the other amputation. Three patients had progressive infrainguinal disease, two requiring intervention and one amputation.
(Conclusion)AIE is a durable option in patients with small vessels and AOID that is limited to aorta and common iliac arteries. Although overall survival is not affected, AIE in setting of acute presentation appears to have higher complication rates and lower patency.
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