Comparative long-term outcomes of patients with aorto-iliac occlusive disease limited to common iliac arteries treated with endarterectomy versus bypass.

Abstract Objective To compare outcomes of patients with aorto-iliac occlusive disease (AIOD) limited to the common iliac territory and treated by either aortoiliac thromboendarterectomy (AIE) or aorto-bi-iliac bypass grafting (ABIB). Methods A single center, retrospective analysis of consecutive patients with AIOD treated either with AIE or ABIB between 2010 and 2019 from a prospective database. Patients with disease extending to the external iliac or common femoral arteries were excluded. Data collected included demographics, cardiovascular risk factors, indication for surgery, pre and postoperative ankle brachial indexes (ABIs), estimated blood loss (EBL), major adverse events (MAEs) and long-term patency. Study endpoint was clinical success, defined as improvement in ABIs with resolution of symptoms. MAEs included return to the operating room for any reason, post-operative myocardial infarction, stroke, pneumonia or venous thromboembolism. Results Thirty-three patients, who met inclusion criteria, underwent repair for AIOD (AIE: 13; ABIB: 20) at our institution during this time. In both groups, there were more female than males (AIE: 11, ABIB: 10) with a mean age of 55±7 and 58±6 in the AIE and ABIB group, respectively. Indication for surgery included disabling claudication in 19 patients, ischemic rest pain in 13 and tissue loss in one. No difference in cardiovascular risk factors or AIOD severity was noted between groups. Patients in the AIE group had slightly higher body mass index (30±5 vs. 26±6, p=0.06 Two patients in each group required concomitant renal/mesenteric artery endarterectomy. One patient in the AIE group required bilateral femoral artery exposure and external iliac thrombectomy. MAEs (4 vs.0) were higher in the ABIB group including, pneumonia in one patient, myocardial infarction in another, return to the operating room for evacuation of hematoma in the third and bypass graft thrombectomy with lower extremity angiography in the fourth patient. There were no differences intensive care unit or hospital length of stay between groups. Patients in both groups achieved return of normal ABI and complete resolution of their symptoms. At mean follow up time of 43.4±25.2 and 52.9±35.4 months in the AIE and ABIB group, respectively, there were no symptomatic recurrence or need for reintervention while two patients in the ABIB group died of non-aortic related issues. Conclusion Both procedures were safe, effective and conferred high long-term primary patency with no need for reintervention in patients with AIOD limited to the common iliac arteries.