Staged thrombendarterectomy for bilateral ileofemoral arteriosclerosis. An alternative approach.

Bilateral ileofemoral obstruction is usually treated by either a transabdominal reconstruction or an axillobifemoral bypass graft. In this report an alternative approach is presented. Twenty-one patients underwent staged bilateral retroperitoneal thrombendarterectomy. In 14 limbs a concomitant femoropopliteal bypass graft was performed. There was no operative mortality, and morbidity rates were low. The only ileofemoral occlusion occurred after 68 months for 5-year and 6-year patency rates of 100% and 93.8% respectively. In addition, 2 femoropopliteal grafts thrombosed, leaving however, the ileofemoral reconstructions patent. These encouraging results make this two-staged approach an attractive alternative to conventional major transperitoneal operations or axillobifemoral bypass grafts with their poor long-term patency rates.