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Long-Term Outcomes of Open Surgical Repair for Complex Aortoiliac Occlusive Disease in the Age of Endovascular Advancements

Year: 2025

Type: article

Abstract: BACKGROUND: Aortoiliac occlusive disease (AIOD) may lead to critical limb ischemia, requiring revascularization. Open repair remains preferred for complex type C and D lesions despite endovascular options. This study evaluated long-term outcomes of open surgical repair in acute and chronic AIOD. METHODS: A single-centre, retrospective analysis was conducted on patients undergoing open AIOD repair (January 2010-December 2020). Primary outcomes included 30-day and long-term mortality; secondary outcomes were graft patency, Rutherford classification improvement, and limb salvage. RESULTS: Seventy-six patients (61% male; mean age 62 ± 10 years) underwent open repair for Trans-Atlantic Inter-Society Consensus (TASC) II type D AIOD. Peripheral arterial disease and prior interventions were common (67 patients, 88%). Elective surgery was performed in 49 patients (64%), while 27 patients (36%) underwent urgent procedures. The 30-day mortality rate was 0% (0/49) for elective cases but 19% (5/27) for urgent cases (P < 0.01). Long-term survival rates at 1, 2, 3, and 5 years were 98% (48/49), 96% (47/49), 94% (46/49), and 86% (42/49) for elective cases versus 78% (21/27), 62% (17/27), 62% (17/27), and 62% (17/27) for urgent cases (P = 0.30), respectively. Elective cases demonstrated high graft patency at 1, 2, 3, and 5 years (96% [47/49], 90% [44/49], 90% [44/49], and 85% [42/49]), respectively. Rutherford classification improved significantly (median preoperative stage 3 to postoperative stage 0, P < 0.001), with stable ankle-brachial index (ABI) values (≥0.9) in 59 of 61 patients (97%). Vascular complications occurred in 39 patients (51%), with reinterventions in 12 patients (16%). Sustained limb salvage was observed over long-term follow-up (median 59 months). CONCLUSION: Open repair for complex AIOD offers durable outcomes, with low elective case mortality and high limb salvage and graft patency. Future studies should explore long-term comparative outcomes.

Source: Annals of Vascular Surgery

DOI: 10.1016/j.avsg.2025.03.007

Authors: V. Makaloski, L. Ilcheva, S. Valcheva-Ilieva, M. Darwish, D. Kotelis, T.R. Wyss

Institutions: University of Bern, University Hospital of Bern, Health Education England, Kantonsspital Winterthur

Language: English

Topic: Peripheral Artery Disease Management

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,560