The underestimated advantages of iliofemoral endarterectomy.

Iliofemoral endarterectomy was invented 50 years ago, but it is seldom practiced today for two reasons. The first is that it is technically challenging and the second is that outcome in early series was poor. Our preliminary experience having been more encouraging, we have continued to perform iliofemoral endarterectomy for the past 20 years. The purpose of this retrospective study was to evaluate our results and compare them with results of alternative techniques described in recent literature. We have performed a total of 176 iliofemoral endarterectomies in patients with normal or nearly normal aortas. The procedure involved the entire network including the common iliac artery, external iliac artery, and common femoral artery in 108 cases (group I), the common iliac artery with or without the external iliac artery in 40 cases (group II), and the external iliac arteries and the common femoral artery with or without the deep femoral artery in 28 cases (group III). From our results we conclude that iliofemoral endarterectomy should be used as a first-choice modality in patients with normal or nearly normal aortas who present with iliac lesions that are either too long for balloon angioplasty or impossible to recanalize. It eliminates the risk of graft infection and false aneurysm. Restenosis can be treated by balloon angioplasty. It also saves the cost of a prosthesis.