Aorto-iliac thrombo-endarterectomy

Abstract

A series of 46 patients, all of whom underwent thrombo‐endarterectomy for occlusive atherosclerotic disease of the abdominal aorta and iiiac arteries, is presented. The operative mortality of the whole series is 10 per cent but in the last 32 cases only 3 per cent. This compares favourably with other published series and other reconstructive procedures. The follow‐up ranges from 6 months to 9 years and averages 2 years 6 months in the 42 postoperative survivors. In this group the patency rate is 90 per cent. The incidence and causation of impotence post‐operatively are discussed and measures suggested for avoiding this complication. Emphasis is laid on the anatomical distribution of the atheroma and its haemodynamic effects as determining factors in the prognosis and the suitability of this disease for treatment by thrombo‐endarterectomy. Further advance in the operative treatment of atherosclerosis of the great abdominal vessels should continue to take an ever‐increasing account of the perfusion and flow problems intimately associated with the disease and its relief.

A Re-Appraisal of Gas Endarterectomy

“…DISCUSSION In the treatment of proximal atheroma our usual policy has been to reserve endarterectomy for unilateral disease and to utilise the more expeditious prosthetic graft in patients with bilateral involvement. The results of this small series of cases, all of which remain patent despite advanced distal disease in the majority, are in accord with general experience for aorto-iliac endarterectomy (Linton 1962;Minken et al 1968;Spiro and Cotton 1970) . The use of carbon dioxide to perform the endarterectomy is of particular value when the procedure extends distally to the common femoral artery.…”

Pilot Study of Sexual Dysfunction Following Abdominal Aortic Aneurysm Surgery

“…[10] suggested that microemboli from arterial clamping or dissection also may contribute to sexual dysfunction. In the neurogenic mechanism, damage to autonomic nerves in the para‐aortic plexus was widely accepted to be the cause of impairment of erection and ejaculation [11–14]. Nerve‐sparing techniques leading to a lower ED rate has been previously reported [8,9].…”

Arterial anatomy and arteriographic diagnosis of arteriogenic impotence

“…Some authors [52,53] conclude that surgical intervention tends to further impair erectile function, but Sabri and Cotton [54] and Michal et al, [55] reported significant improvement in prospective studies. They especially were interested in preservation of the integrity of the hypogastric plexus by increased use of thromboendarterectomy to the internal lilac arteries.…”