Eversion Endarterectomy – An Alternative Approach to Occlusive External Iliac Artery disease

• Published in: Annals of vascular surgery Vol. 83; pp. 290 - 297
• Main Authors: Foley, Megan Power, Aherne, Thomas M., Dooley, Conor, Mulkern, Edward, McDonnell, Ciaran O., O'Donohoe, Martin K.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.07.2022
• Subjects: Eversion endarterectomy; Iliofemoral occlusive disease; Surgical outcomes; Iliofemoral occlusive disease; Surgical outcomes; Eversion endarterectomy
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2021.12.005

•Single-centre retrospective study of eversion endarterectomy for TASC-II C-D EIA lesions.•Five-year primary and primary-assisted patency rates were 74% and 92%, respectively.•More durable patency than endovascular approaches and fewer complications than open bypass.•Eversion endarterectomy is a safe and effective technique for occlusive EIA disease. While endovascular intervention is the recommended first option for management of common iliac artery (CIA) lesions, it lacks durable patency for Trans-Atlantic Inter-Society Consensus (TASC)-II C and D lesions involving the external iliac artery (EIA). Aorto-femoral bypass is a durable option but is unsuitable in patients with significant co-morbidities. Eversion endarterectomy provides an alternative to both endovascular and extensive open aortoiliac reconstruction for occlusive EIA disease. A single-center, retrospective review (2000–2020) of all patients undergoing eversion endarterectomy for EIA disease was undertaken. Demographic, clinical, operative and follow-up data were recorded. Fifty eversion endarterectomies were performed in 47 patients. The median age was 65.0 years (range 46–82) and 66.6% were male. Sixty-eight percent (n = 34) were ASA grade 3. Indications for intervention were disabling claudication (44%) and critical limb ischaemia (56%). Angiography demonstrated 22 TASC C and 28 TASC D lesions. The median follow-up was 18.5 months (range 0–149). The technical success rate was 100%, and 84% (n = 42) experienced an immediate symptomatic improvement. Primary and primary-assisted patency at one, three and five years was 86%, 82% and 74%, and 100%, 96% and 92%, respectively. The five-year limb salvage rate was 96%. Eight limbs required reintervention to maintain patency, either by open (n = 2), endovascular (n = 3) or hybrid approach (n = 3). Thirty-day mortality was 2% (n = 1) with 10% (n = 5) experiencing a procedure-related morbidity. All-cause mortality was 38% (n = 19) during the follow-up period. Eversion endarterectomy is a safe, effective alternative treatment for occlusive EIA disease. This study reports durable patency at five years and low perioperative morbidity and mortality.