American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Remote endarterectomy may be safer than bypass for AIOD

OCTOBER 23, 2017
Clinical Congress Daily Highlights, Monday First Edition

Aortobiiliofemoral remote endarterectomy outperforms aortobifemoral bypass as a treatment for aortoiliac occlusive disease (AIOD), a new study concludes.

Research led by Zach M. Feldman, a student at the Icahn School of Medicine at Mount Sinai, New York, NY, found that six-year patency rates of 100 percent were achieved for an aortobiiliofemoral remote endarterectomy case series of eight patients, with no postoperative complications or morbidities seen with the use of prosthetic grafts.

Although aortobifemoral bypass can restore lower extremity blood flow for those with AIOD, a tradeoff is the potential for significant complications, impacting morbidity and mortality. The study shows that remote endarterectomy offers an alternative approach, avoiding many complications while demonstrating excellent results.

In a single-institution study, eight patients with AIOD were treated combining direct and remote endarterectomy. Their mean age was 59.1 years; 88 percent were male, 75 percent hypertensive, 100 percent had smoking history, and 38 percent had prior peripheral arterial disease intervention. Revascularization was achieved in all cases, with average ankle-brachial indices improving from 0.42 to 0.92 postoperatively (0.91 at eight-month follow up). 

No myocardial infarctions, strokes, deaths, amputations, intestinal ischemia, aortocaval and aortoenteric fistula development, sexual dysfunction, or aneurysmal degeneration were observed. 

Additional Information:
The Scientific Forum presentation, Aortobiilliofemoral Remote Endarterectomy for Aortoiliac Occlusive Disease – a Compelling Alternative to Bypass, was held October 23 at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA.  Program, webcast and audio information is available online at FACS.org/clincon2017.

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