Long-term results of aortoiliac reconstruction.

To facilitate evaluation of new and evolving interventional strategies in the management of aortoiliac occlusive disease, the collective long-term experience with traditional operative reconstruction was reviewed. Endarterectomy, currently the procedure of choice for a limited number of patients with disease localized to the aorta and common iliac arteries, has demonstrated 10-year primary patency rates of 48%-77%. By comparison, prosthetic in situ replacement or bypass grafting, commonly performed for more extensive lesions and in the presence of aneurysmal degeneration or total occlusion of the aorta, has yielded 10-year primary patency rates of 62%-79%. Cumulative graft patency can often be extended by means of thrombectomy, thrombolysis, and repair of thrombosed graft limbs, with 20-year extended cumulative patency rates of 49%-68%. The long-term success of operative reconstruction is highly dependent on the extent of coexistent peripheral occlusive disease, with progression of outflow disease representing the single most important factor associated with thrombosis of endarterectomy sites or prosthetic bypass grafts. Further improvements in long-term outcome for all modes of intervention in aortoiliac occlusive disease require increased attention to the minimization of risk factors associated with the underlying atherosclerotic disease process.