Long-Term Outcomes of Hybrid-Based Iliofemoral Endarterectomy for Severe, Extensive Occlusive Disease.

BACKGROUND

Iliofemoral peripheral arterial disease is contemporarily managed via endovascular approaches and groin cutdown, given the morbidity associated with open surgical reconstructions. However, endovascular reconstruction is afflicted with high rates of restenosis. Our group has previously shown that hybrid-based retrograde iliofemoral endarterectomy is safe, efficacious, and yields excellent outcomes at 1-2 years. This study aims to show ongoing outcomes at 5 years or greater.

METHODS

This study is a single-institution, retrospective review of 125 hybrid-based, retrograde iliofemoral endarterectomies from January 1, 2010, to November 1, 2022. Data collected from electronic medical records were analyzed using standard quantitative statistical techniques. The primary outcomes were mortality and freedom from major amputation. The secondary outcomes included patency rates and changes in ankle-brachial index (ABI) and toe pressures.

RESULTS

A total of 125 limbs in 111 patients were included in this study. Fifty-seven percent of patients presented with critical limb ischemia. Ninety-seven percent of patients had TransAtlantic Inter-Society Consensus II C or D lesions. The average length of follow-up was 29 ± 32 months (range 0-125 months). Freedom from major amputation was 98%, and the primary patency rate was 90% at last follow-up. ABIs improved from 0.43 ± 0.19 to 0.74 ± 0.23 (P < 0.01), and toe pressures improved from 32 ± 23 mm Hg to 65 ± 32 mm Hg (P < 0.01).

CONCLUSION

Hybrid-based, retrograde iliofemoral endarterectomy is a safe and efficacious treatment option for patients with severe iliofemoral occlusive disease. It provides excellent long-term primary patency and improvement in ABI. This technique should be considered during femoral endarterectomy with external/common iliac reconstruction as a means of achieving minimally invasive, durable, long-term patency.