Extraperitoneal iliac endarterectomy in the treatment of multilevel lower extremity XXXX .

@entity1 @entity432 @entity63
The traditional approach to the surgical correction of lower extremity @entity63 resulting from combined aortoiliac and femoropopliteal disease has consisted of aortofemoral bypass as the initial step. This operation is of considerable magnitude, mandates the use of prosthetic material, and may not adequately relieve @entity63 . Extraperitoneal iliac endarterectomy is an operation of lesser magnitude and does not require the use of prosthetic material. When applied to selected @entity1 with multilevel disease, it can be conveniently and expeditiously combined with distal bypass and deep femoral repair, femorofemoral bypass, or both for the simultaneous and complete correction of multilevel disease. In the past 10 years, 65 @entity1 underwent simultaneous extraperitoneal iliac endarterectomy in combination with an outflow procedure for the correction of multilevel lower extremity @entity432 . Using a two-team approach, operative time averaged 3 hours. Operative mortality was 5 percent. The procedure was combined with femoral endarterectomy in 60 @entity1 , with femoropopliteal-to-tibial bypass in 30 @entity1 , and with femorofemoral bypass in 10 @entity1 . The life table patency for iliac endarterectomy was 100 percent at 6 years, whereas patency for the associated outflow procedures was 87 percent at 6 years. These results indicate that extraperitoneal iliac endarterectomy is uniquely suited for combination with distal procedures to permit the simultaneous repair of combined aortoiliac and femoropopliteal disease in a single operation of reasonable magnitude.
