Long-term Results of Reconstructive Surgery for the Unilateral Aortoiliac Occlusive Disease and Future Risks of Contralateral Iliac Events

Objective: Our experience with unilateral iliac reconstructive surgery was retrospectively reviewed, and the long-term patency and the morphological information was disclosed. In addition, the prognosis of contralateral iliac artery was examined, because future contralateral iliac events seem to be important for durability of unilateral iliac revascularizations.

Materials and methods: 148 patients (mean age, 66.9 years; 88% male) who had undergone unilateral aortoiliac reconstruction without contralateral iliac lesions were evaluated. The unilateral aortoiliac reconstructive procedures included 112 (76%) aorto or iliofemoral bypasses, 27 (18%) femorofemoral bypasses, and 9 (6%) axillofemoral bypasses. The indications for arterial reconstruction were disabling claudication and limb salvage in 125 (84%) and 23 (16%) patients, respectively. Preoperative arteriograms were reviewed to determine the Inter-Society Consensus (TASC II) classification categorizing iliac artery lesions. Contralateral iliac events were defined as any arterial reconstructive procedure, intervention, amputation for progression of contralateral iliac disease, or repair of abdominal aortic aneurysm (AAA). The Kaplan-Meier survival analysis was used to predict long-term results in patients grouped based on various factors which were compared using univariate and multivariate analyses.

Results: In the 148 patients, unilateral iliac reconstructive procedures were undertaken in 83 (56%) patients with TASC II type D lesions, 34 (23%) patients with TASC II type C lesions, and 31 (21%) patients with TASC II type B lesions. Overall primary and secondary patency rates were 93.8% and 96.5% at 3 years and 90.0% and 93.9% at 5 years. A multivariate analysis disclosed critical limb ischemia influencing primary patency rates, and type of aortoiliac reconstruction or gender influencing secondary patency rates. TASC II classification did not affect primary or secondary patency rates. During the follow-up period, 15 contralateral iliac events occurred, including 11 aortoiliac reconstructive or interventional procedures, 3 repairs of AAA, and one case of bilateral thigh amputation due to acute aortic occlusion. The overall probability of contralateral iliac events was 2.2% at 3 years and 5.9% at 5 years.

Conclusion: The long-term patency following unilateral iliac reconstructive surgery was satisfactory, and not affected by morphology of the iliac artery. Also, the future risk of contralateral iliac events appeared to be low.