Revascularization of internal iliac arteries during aortoiliac surgery: a multicenter study.

In 1995, a total of 1785 patients underwent elective aortoiliac surgery at 35 centers in France, including 1024 for abdominal aortic aneurysm (57.4%) and 761 for occlusive aortoiliac lesions (42.6%). Direct revascularization of the internal iliac artery was performed in 11.2% of patients with both distal anastomoses located below the iliac bifurcations (18.4% with aneurysm vs. 6.8% with occlusive lesions, p < 0.001). Associated revascularization of the inferior mesenteric artery was performed in 9% of patients (11.5% with aneurysms vs. 5.5% with occlusive lesions, p < 0.001). Postoperative colonic ischemia was observed in 21 patients (1.2%) (1.2% with aneurysms vs. 1.2% with occlusive lesions) and claudication in the gluteal region was observed in 31 patients (1.7%) (1.5% with aneurysms vs. 2.1% with occlusive lesions). Revascularization of the internal iliac artery, regardless of the technique, had no significant effect on the incidence of postoperative colonic ischemia and claudication in the gluteal region-neither after surgery for aneurysm (0.6% vs. 2.1% and 1.2% vs. 1.9%, respectively) nor after surgery for occlusive lesions (0.9% vs. 0.4% and 1.5% vs. 2.6%, respectively). Whether performed routinely or not, revascularization of the mesenteric artery has no significant effect on the incidence of postoperative colonic ischemia (1.1% vs. 1.3%).