Surgery Advised for Severely Narrowed Iliac Arteries

A new study suggests that surgery is the best option for aortoiliac occlusive disease (AIOD), a disorder of the circulatory system that occurs when the iliac arteries narrow or become blocked.

Researchers at Yale University School of Medicine (Yale, New Haven, CT, USA) and McMaster University (Hamilton, Canada) systematically searched studies on open and endovascular treatment for AIOD published from 1989 to 2010, identifying 29 open bypass studies involving 3,733 patients, and 28 endovascular treatment studies involving 1,625 patients. Assuming between-study heterogeneity due to bias inherent to observational studies, a random effects model was used for calculation of weighted proportions.


The results showed that poor preoperative runoff was greater in the open bypass group. Mean length of hospital stay was 13 days for open bypass, compared to 4 days for endovascular treatment procedures. The open bypass group also experienced more complications and greater 30-day mortality. On the other hand, at 1, 3, and 5 years, primary patency rates were greater in the open bypass group than the endovascular cohort; the same was true for secondary patency. The study was published in the August 2013 issue of the Journal of Endovascular Therapy.

“There is a trend to higher complication rates in direct open repair compared to endovascular repair based on our review, but the complication rate following endovascular procedures is higher than that previously reported,” concluded lead author Jeffrey Indes, MD, of Yale, and colleagues. “Direct open repair still remains the more durable option and should be offered to patients who are suitable and able to withstand the rigors of laparotomy. Endovascular repair is a viable alternative and perhaps an appropriate first-line treatment in certain patients.”

AIO is an atherosclerotic occlusive disease involving the abdominal aorta and/or both of the iliac arteries. Classically, it is described in male patients as a triad of symptoms consisting of claudication of the buttocks and thighs, absent or decreased femoral pulses, and impotence, a combination known as Leriche syndrome. However, any number of symptoms may present, depending on the distribution and severity of the disease, such as muscle atrophy and slow wound healing in the legs.

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Yale University School of Medicine
McMaster University