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*UNILATERAL ILIOFEMORAL SYMPTOMATIC OCCLUSIVE DISEASE – THE RESULTS OF SEMI‐CLOSED ENDARTERECTOMY USING A RING‐STRIPPER
Author(s) -
Muller J. C.,
Ogg M. J.,
Mcgahan T. J.,
Quinn J. M.,
Woodruff P. W.,
Mayer R. C.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04935_2.x
Subject(s) - medicine , surgery , endarterectomy , claudication , amputation , thrombosis , intermittent claudication , vascular disease , arterial disease , carotid arteries
Purpose: Symptomatic unilateral occlusive iliofemoral disease is a common scenario in vascular surgical practice and its management is controversial as there are many revascularisation options. This study reviews semi‐closed iliofemoral endarterectomies using a ring stripper to report its efficacy, complications and longer‐term results. Methodology: A retrospective review of 80 consecutive semi‐closed endarterectomies performed in 78 patients at our institution between 1998 and 2008. Mean age was 66. Surgical indications were for limb threatening ischaemia in 27 patients and disabling intermittent claudication in 53. Concurrent revascularisation procedures included 25 profundaplasties and 21 infra‐inguinal bypasses. Results: Technical success was achieved in 92.5% of cases. 6 cases required alternative bypass or open endarterectomy and there was one perforation. There was no peri‐operative mortality. Major amputation was required in one patient. Postoperative thrombosis requiring early thrombectomy occurred in one patient. Follow‐up was for a mean of 36 months. The cumulative primary patency rate at 3 years was 86.2% and 88.8% for limb salvage. The patients who presented with limb threatening ischaemia compared to the claudicants were more likely to have multi‐level disease requiring concurrent revascularisation (66.7% vs. 35.8% p = 0.01), and were also at significantly increased risk of major amputation (30.8% vs. 4.0% p = 0.04) and mortality (58.3% vs. 28.6% p = 0.04) during follow‐up. Conclusion: Treatment of long segment occlusive concurrent external iliac and common femoral artery disease is best individualised however semi‐closed endarterectomy using a ring stripper is an effective, safe and durable procedure.