Is the iliac artery a suitable inflow conduit for iliofemoral occlusive disease: an analysis of 514 aortoiliac reconstructions.

PURPOSE

The aorta is the conventional inflow source for reconstructions in patients with aortoiliofemoral occlusive disease. In patients with unilateral iliac or femoral disease, femoral-to-femoral bypasses have been used but with less favorable patency rates. The purpose of this study is to evaluate the performance of the unobstructed iliac artery as an inflow source for ipsilateral, contralateral, or bilateral reconstructions in iliofemoral occlusive disease.

METHODS

Over the past 6 years 322 reconstructions have been performed with the iliac artery as the donor vessel. Patients were evaluated for proximal hemodynamically significant lesions by augmented pullout pressures during aortography. Patients who had balloon angioplasty were excluded.

RESULTS

Results were compared with 192 patients who underwent conventional aortodistal bypass operation for occlusive disease during the same period. Both groups were similar in risk factors, age, sex, and indications for operation. For the iliac group the operative mortality rate was 1.6%, and the 30-day patency rate was 97%, similar to those in the aortic group (3.6% and 95%, respectively). Cumulative patency rates at 5 years by life-table analysis were 82% for iliac artery inflow and 77% for aortic inflow reconstructions.

CONCLUSIONS

Our experience suggests that an unobstructed iliac artery is a reasonable inflow source for reconstructions in iliofemoral occlusive disease. The long-term patency rate is comparable to aortodistal bypasses and superior to other extraanatomic bypasses.