RETROGRADE ILIOFEMORAL ENDARTERECTOMY FACILITATED BY BALLOON ANGIOPLASTY

Purpose: The purpose of this study was to explore the feasibility of i liofemoral endarterectomy performed through a single groin incision. M ethods: Thirty-two patients aged 34 to 75 years (mean age 63.4 years) with a male/female ratio of 20:12 underwent 36 lower extremity inflow reconstructions from July 1989 to September 1994. Surgical, indication s were for limb-threatening ischemia in 24 patients and for claudicati on in eight patients. The procedures were done for occlusive disease o f the external iliac artery and common femoral artery with patients un der either spinal (n = 24) or local (n = 12) anesthesia. Intraoperativ e balloon angioplasty with fluoroscopic guidance preceded open retrogr ade iliofemoral endarterectomy. Adjunctive procedures included 18 prof undaplasties, eight femorofemoral, nine femoropopliteal, and one femor otibial bypasses. Results: Thirty-three of the 36 cases were initially successful. The three failures were in patients with extensive calcif ication. The mean follow-up has been 36.4 months, and the patency rate was 80.5% at 3 and 4 years. The four failures noted on follow-up were caused by three common iliac artery stenoses and one iliac system occ lusion. The former group was successfully treated with balloon angiopl asty/stent, and the latter patient required an aortofemoral bypass. No operative deaths or limb loss occurred in this series. Conclusions: R etrograde iliofemoral endarterectomy facilitated by balloon angioplast y is a safe, easy-to-perform, and viable option for patients with comb ined external iliac artery and common femoral artery occlusive disease . Midterm results (36.4 months) are favorable, and most hemodynamic fa ilures are easy to correct with standard endovascular techniques.