Shigematsu H

Unilateral arterial reconstruction for aortoiliac occlusive disease

METHODS The outcomes of 234 arterial bypasses for aortoiliac occlusive disease were retrospectively analyzed. Surgical procedures included 60 bilateral aorto-/iliofemoral bypasses, 140 unilateral aorto-/iliofemoral bypasses, and 34 femorofemoral cross-over bypasses. Nineteen patients (13.6%) showed deterioration of the contralateral iliac artery after the initial unilateral operation. Of these patients, 11 patients underwent further surgical treatments; including 5 unilateral aortofemoral operation bypasses, 2 iliac thromboendarterectomies, 2 iliac PTAs, 1 femorofemoral bypass, and 1 bilateral aortofemoral bypass. The remaining 8 patients received conservative treatment because of their risk factors. The patency rate of the unilateral reconstruction has improved during the last 12 years according to our historical analysis. RESULTS Our results demonstrate that unilateral vascular reconstruction is a valuable alternative to conventional bilateral reconstruction in unilateral symptomatic aortoiliac occlusive disease. CONCLUSIONS Accurate preoperative diagnosis and early detection of the progression of sclerotic lesions on the contralateral side are the keys to successful results.