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.