Remote Iliac Artery Endarterectomy

Abstract

Objectives: Remote endarterectomy of external and common iliac artery occlusions through a single, groin incision under fluoroscopic guidance is a relatively unknown surgical procedure. This prospective singlecenter cohort study describes this less invasive endovascular technique with the ring strip cutter and its early complications. The results at midterm follow-up are presented.Methods: From April 2004 to July 2010, 49 remote endarterectomies of the external or common iliac artery were performed in a retrograde manner from a single, groin incision in 48 patients (30 men, 31 procedures). The median age was 66 years (range, 39-82 years). Indications for operation were severe claudication in 28 (57%), rest pain in 13 (27%), and gangrene in 8 (16%) procedures. Follow-up included clinical evaluation, ankle-brachial index, and duplex scanning at 6 weeks, 3 months, and yearly thereafter. Results: Intraoperative technical success was achieved in 43 procedures (88%). A retroperitoneal incision was necessary in three patients for an additional arteriotomy in the iliac artery and in three others for a bypass procedure. The mean follow-up was 20 months (range 2-77 months). Three-year cumulative primary patency rate by means of lifetable analysis was 60.2% Ϯ 12.0% (SE). During follow-up, percutaneous transluminal balloon angioplasty with and without stenting was performed in six and two patients, respectively, resulting in a 3-year primaryassisted patency rate of 85.7% Ϯ 9.56%. Three-year secondary patency was 94.2% Ϯ 5.50%.Conclusions: Remote endarterectomy in external and common iliac arterial occlusive disease is a feasible endovascular procedure with a low complication rate. The midterm primary-assisted patency rate is good.