Loop endarterectomy from the iliac arteries and aorto-femoral bypass surgery: long-term results
AbstractObjectives. Remote iliac artery endarterectomy is disputable technique of restore patency of iliac arteries, whereas iliac artery bypass is a “gold standard” treatment lesion of iliac artery TASC C and D, but more invasive. The aim of study evaluatelong-term outcomes of remote endarterectomy from iliac artery and comparative with iliac artery bypass.
Material and methods. A retrospective cohort study identified patients with aorto-iliac arteries lesion TASC C and D treatment with remote iliac artery endarterectomy (n=83) and iliac artery bypass (n=63). The outcomes were patency (primary, primary-assisted, secondary, patency association with SFA lesion), survival, freedom from cardiovascular events. Proportional hazard regression model were used to analyze predictors of restenosis/reocclusion.
Results. A total of 146 procedures were analyzed. The mean follow-up period was 54.1 months. There was no 30-day mortality in both group. 30-day occlusion in 4 (6.35%) patient in IAB group. There was no 30-day amputation in group 1, but 2 (3.17%) cases in group 2. Primary patency in group 1 and 2 at 12, 24, 60 months was 87.5; 82.8; 66.6% and 93.5; 93.5; and 90.1%, respectively (p<00001). Primary-assisted patency and secondary patency was no significant difference in both group (p=0.553 and p=0.582). 5-year limb salvage and freedom from cardiovascular events was no significant difference (p=0.134 and p=0.113). 5-year survival was significantworse in group 2. At multivariable analysis in group REIA age > 65 y.o. (HR 5.363; 95% Confident interval (CI) 1.194–24.097; p=0.028) and SFA lesion without intervention (HR 3.460; CI 0.957–12.513; p=0.058) were independently associated with loss of primary patency.
Conclusion. Our study demonstrateIAB is durable procedure for long lesion iliac artery. However, native occlusion may have a risk of early graft occlusion. Occlusion of SFA in long term period is not lower patency of IAB. Although REIA less invasive procedure, long term patency is not well. Age over 65 and SFA lesion without procedures increase risk of reocclusion iliac arteries.
Funding. The study had no financial support.
Conflict of interest. The authors declare no conflicts of interest.
Authors’ contribution. Study conception and design – Oborin A.A.; data collection and handling – Oborin A.A.; statistical processing – Oborin A.A.; draft manuscript preparation – Oborin A.A.; manuscript revision – Mukhamadeev I.S.
For citation: Mukhamadeev I.S., Oborin A.A. Loop endarterectomy from the iliac arteries and aorto-femoral bypass surgery: long-term results. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 91–8. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-91-98 (in Russian)
Keywords: endarterectomy; bypass; atherosclerosis; risk factor
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