The underestimated advantages of iliofemoral endarterectomy

Iliofemoral endarterectomy was invented 50 years ago, but it is seldom prac ticed today for two reasons. The first is that it is technically challengin g and the second is that outcome in early series was poor. Our preliminary experience having been more encouraging, we have continued to perform iliof emoral endarterectomy for the past 20 years. The purpose of this retrospect ive study was to evaluate our results and compare them with results of alte rnative techniques described in recent literature. We have performed a tota l of 176 iliofemoral endarterectomies in patients with normal or nearly nor mal aortas. The procedure involved the entire network including the common iliac artery, external iliac artery, and common femoral artery in 108 cases (group I), the common iliac artery with or without the external iliac arte ry in 40 cases (group II), and the external iliac arteries and the common f emoral artery with or without the deep femoral artery in 28 cases (group II I). From our results we conclude that iliofemoral endarterectomy should be used as a first-choice modality in patients with normal or nearly normal ao rtas who present with iliac lesions that are either too long for balloon an gioplasty or impossible to recanalize. It eliminates the risk of graft infe ction and false aneurysm. Restenosis can be treated by balloon angioplasty. It also saves the cost of a prosthesis. DOI: 10.1007/s100169910068.