Eversion endarterectomy of the external iliac artery

Abstract

Introduction. To redraw attention to the meaning and value of eversion endarterectomy (EA) of external iliac arteries as a still effective surgical method used in the treatment of advanced arterial occlusive disease. The authors of this article would like to present their experience in this scope.

Material and methods. This is a presentation of the applied method of treatment; it comprises the descriptions of nine consecutive cases of patients suffering from atherosclerotic stenosis or occlusion of external iliac arteries and advanced lower limb ischaemia, manifesting in a short distance of claudication, rest pain and commencing necrotic lesions in the lower limbs, who were operated on in the years 2013–2014, for whom the restoration of patency in the external iliac arteries was achieved by use of eversion endarterectomy. It also comprises two other patients for whom the restoration of patency in the external iliac arteries was achieved by eversion endarterectomy but who were operated on for acute lower limb ischaemia.

Results. In all but one patient the restoration of patency by eversion endarterectomy was successful, resulted in improvement of blood flow in the limb and reduction of the patients’ ailments. In one case there was no improvement and the patient required more surgical interventions. In the same case a retroperitoneal aneurysm arose, requiring surgical removal. In another case early thrombosis of the operated artery developed and was successfully treated with thrombectomy. The other patients reported alleviation or absence of pain directly after the surgery. In our patients’ group we noted one serious undesired extra-vascular event — a myocardial infarction type 2. Mortality after 30 days was zero.

Conclusions. Eversion endarterectomy of the external iliac artery is an effective and relatively simple surgical method of known and proven effectiveness. It constitutes a bit forgotten but valuable supplement to an armamentarium of surgical methods in the treatment of atherosclerosis of an aortoiliac segment.