Long-term results after open and semiclosed thrombendarterectomy for aortoiliac. Occlusive disease

Objectives:This study reviews the long-term results of 514 aortoiliac thrombendarterectomies (TEA's).Design:A prospective study in a major university hospital in Switzerland.Subjects:353 male and 62 female patients with aortoiliac occlusive disease. Operative indications: disabling claudication (n = 334), rest pain (n = 44), and gangrene (n = 37).Methods:Open and semiclosed TEA's were performed on 167 and 347 limbs, respectively. Follow-up was continuous and complete in 97.1 % of patients over a period of more than 15 years.Results:The overall life-table patency rate at 5, 10, and 15 years postoperatively were 93.4 %, 90.4 %, and 84.2 %, respectively. Fifteen years postoperatively, the patency rate of 92.3 % after open TEA was significantly higher (p < 0.04) than after semiclosed TEA (79.5 %). However, similar patency rates of 69.5 % and 69.8 % were observed 20 years postoperatively. Further significant prognostic factors on patency were: anatomic localization (p < 0.004), preoperative stage of arterial occlusive disease (p < 0.008), and gender (p < 0.007). Patient's age did not influence the outcome in terms of patency. Hospital mortality rate was 1.2 %. Early obstruction occurred in 2.2 %, leading to subsequent early amputation in 1.4 % and reoperations in 1.2 %. The long-term actuarial survival rates of the patients were 55 %, 36 %, and 18 % after 10, 15, and 20 years postoperatively.Conclusion:Both open and semiclosed TEA give highly satisfactory long term results in aortoiliac occlusive disease with a low morbidity and low mortality