ENDARTERECTOMY VERSUS ANGIOPLASTY IN THE TREATMENT OF LOCALIZED STENOSIS OF THE ABDOMINAL-AORTA

Objective: To compare the outcome after aortoiliac endarterectomy and percutaneous transluminal angioplasty (PTA) of the aorta for localized stenosis of the lower abdominal aorta. Design: Chart review of patien ts treated over a 5-year period. Setting: A university centre. Patient s: Sixteen women, all of whom were smokers; 5 had hyperlipidemia, 4 ha d evidence of coronary artery disease, 3 were hypertensive, and 1 was diabetic.Interventions: Aortoiliac endarterectomy (eight women) and PT A (eight women). Main Outcome Measures: Ankle-brachial pressure index (ABI), degree of claudication and clinical outcome. Results: Angiograp hy showed localized stenosis of the lower aorta in all patients, aorti c hypoplasia in nine patients and associated common iliac disease in s even. None of the eight patients managed by aortoiliac endarterectomy had complications or died. All were free of claudication at a mean fol low-up of 29 months and had durable improvement in their ABI: mean ABI preoperatively was 0.69 (standard deviation [SD] 0.1) and postoperati vely was 1.06 (SD 0.07). Of the eight patients treated by PTA, only on e had partial dilatation; another had a subintimal tear with worsening symptoms and a fall in ABI, requiring surgery within 18 months. The r emaining six were symptom free after a mean follow-up of 13.4 months. Aortic PTA resulted in improvement of the ABI: mean ABI before PTA was 0.69 (SD 0.19) and after PTA was 1.06 (SD 0.15). Conclusions: Endarte rectomy is a safe and effective method of treating occlusive disease l imited to the distal aorta. PTA appears to be less reliable. However, it is recommended as the initial treatment of choice in patients with angiographically suitable lesions because it is less invasive.