Semiclosed iliac recanalisation by an inguinal approach - Modified surgical techniques integrating interventional procedures

Objectives: technical success and early outcome of modified surgical techni ques integrating interventional procedures for iliac recanalisation perform ed through an incision in the groin. Materials: sixty-one consecutive iliac arteries in 59 patients with long oc clusions in 16 occlusions of the common iliac in II, occlusions of the exte rnal iliac in 24 and multiple stenoses of the iliac in IO cases underwent s emiclosed recanalisation through a groin incision. Methods: passage of the lesion by guidewire permits retrograde ring-strippe r endarterectomy over the wire as a guiding splint or thrombectomy with a d ouble lumen balloon catheter. Residual lesions are corrected by balloon or stent angioplasty. Adequate outflow is established by femoral patch plasty. Results: conversion to a standard operation was required in 10 limbs (failu re to recanalise the lesion in nine, rupture after angioplasty in one). Ini tial technical success was achieved in the remaining 51 limbs (recanalisati on by ring stripper endarterectomy in 36, thrombectomy in 14, both in six, additional intraoperative angioplasty in 42). Five postoperative thromboses were successfully treated by a combined surgical and interventional approa ch accounting for a I-month 100% secondary patency. Conclusion: iliac recanalisation through the groin by modified ring strippe r endarterectomy or modified thrombectomy in combination with intraoperativ e angioplasty is a safe and effective procedure. Long-term results are requ ired to evaluate the procedure.