Iliofemoral endarterectomy (EA) is now considered by most vascular surgeons
to be an obsolete technique that is difficult and unreliable. The purpose
of this retrospective study was to reassess the place of iliofemoral EA on
the basis of long-term outcome in our experience. From 1982 to 1995, we per
formed a total of 121 iliofemoral EA procedures on 98 patients with a mean
age of 57 years. The anatomical presentation involved iliac occlusion in 55
cases and complex iliac stenosis in 63. The indication for treatment was c
ritical ischemia in 28 cases. Operative mortality was nil. Major amputation
was required in only one patient because of contralateral thrombosis durin
g the procedure. Postoperative thrombosis requiring early thrombectomy occu
rred in five cases. At 5 and 10 years, actuarial rates were 77.6% and 61.3%
, respectively, for survival, 98.3% and 90.1%, respectively, for limb salva
ge, 78.9% and 65.1%, respectively, for primary patency, and 88.2% and 73.8%
, respectively, for secondary patency. On the basis of these findings, we c
onsider iliofemoral EA to be a viable alternative to iliac bypass in patien
ts ineligible for transluminal angioplasty.