UNILATERAL VASCULAR RECONSTRUCTION FOR ILIAC OBSTRUCTIVE DISEASE

Purpose: Controversy exists regarding the extent of vascular reconstru ctive surgery in the presence of unilateral symptomatic iliac obstruct ive disease. This study reviews the results of unilateral iliac recons truction, with special emphasis on the need for consecutive contralate ral intervention. Methods: The outcomes of 184 unilateral and 350 aort obilateral reconstructions for obstructive disease performed during th e same period were retrospectively analyzed. Treatment allocation was based on hemodynamic parameters. Unilateral reconstruction was perform ed by a way of a retroperitoneal approach through a pararectal incisio n and bilateral reconstruction by way of a transperitoneal approach th rough a midline abdominal incision. Results: Symptom relief, improveme nt of noninvasively measured parameters, and graft patency were simila r after unilateral and bilateral reconstruction. Both groups had a 10- year primary patency rate greater than 80%. There were no differences in morbidity rate, although respiratory complications occurred more of ten after bilateral reconstruction. Mortality rates were 1.6% after un ilateral reconstruction and 4.9% after bilateral reconstruction. Secon dary contralateral reconstruction was performed in only 6% of the pati ents who underwent an initial unilateral operation. Conclusions: The u nilateral vascular reconstruction for iliac obstructive disease is a w ell-tolerated procedure with an excellent long-term outcome. It is a v aluable alternative to conventional aortobilateral reconstruction in c arefully selected patients. Prophylactic reconstruction of an asymptom atic iliac stenosis without signs of significant hemodynamic impairmen t is most often not indicated.