Highlights
- •Single-centre retrospective study of eversion endarterectomy for TASC-II C-D EIA lesions.
- •Five-year primary and primary-assisted patency rates were 74% and 92%, respectively.
- •More durable patency than endovascular approaches and fewer complications than open bypass.
- •Eversion endarterectomy is a safe and effective technique for occlusive EIA disease.
Objectives
While endovascular intervention is the recommended first option for management of
common iliac artery (CIA) lesions, it lacks durable patency for Trans-Atlantic Inter-Society
Consensus (TASC)-II C and D lesions involving the external iliac artery (EIA). Aorto-femoral
bypass is a durable option but is unsuitable in patients with significant co-morbidities.
Eversion endarterectomy provides an alternative to both endovascular and extensive
open aortoiliac reconstruction for occlusive EIA disease.
Materials and Methods
A single-center, retrospective review (2000–2020) of all patients undergoing eversion
endarterectomy for EIA disease was undertaken. Demographic, clinical, operative and
follow-up data were recorded.
Results
Fifty eversion endarterectomies were performed in 47 patients. The median age was
65.0 years (range 46–82) and 66.6% were male. Sixty-eight percent (n = 34) were ASA grade 3. Indications for intervention were disabling claudication
(44%) and critical limb ischaemia (56%). Angiography demonstrated 22 TASC C and 28
TASC D lesions. The median follow-up was 18.5 months (range 0–149). The technical
success rate was 100%, and 84% (n = 42) experienced an immediate symptomatic improvement. Primary and primary-assisted
patency at one, three and five years was 86%, 82% and 74%, and 100%, 96% and 92%,
respectively. The five-year limb salvage rate was 96%. Eight limbs required reintervention
to maintain patency, either by open (n = 2), endovascular (n = 3) or hybrid approach (n = 3). Thirty-day mortality was 2% (n = 1) with 10% (n = 5) experiencing a procedure-related morbidity. All-cause mortality was 38% (n = 19) during the follow-up period.
Conclusions
Eversion endarterectomy is a safe, effective alternative treatment for occlusive EIA
disease. This study reports durable patency at five years and low perioperative morbidity
and mortality.
Keywords
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Article Info
Publication History
Published online: December 21, 2021
Accepted:
December 4,
2021
Received in revised form:
November 27,
2021
Received:
September 3,
2021
Identification
Copyright
© 2021 Published by Elsevier Inc.
