Long-Term Outcomes of Hybrid-based Iliofemoral Endarterectomy for Severe, Extensive Occlusive Disease

Jarred A Napier; Patrick J Kato; Vikram Sundararaghavan; Michael J Heidenreich; Abdulhameed Aziz

doi:10.1016/j.avsg.2025.06.028

Long-Term Outcomes of Hybrid-based Iliofemoral Endarterectomy for Severe, Extensive Occlusive Disease

Ann Vasc Surg. 2025 Jun 27:S0890-5096(25)00454-6. doi: 10.1016/j.avsg.2025.06.028. Online ahead of print.

Authors

Jarred A Napier¹, Patrick J Kato², Vikram Sundararaghavan², Michael J Heidenreich², Abdulhameed Aziz³

Affiliations

¹ Department of Surgery, Section of Vascular and Endovascular Surgery, Trinity Health Ann Arbor. Electronic address: jarred.a.napier@gmail.com.
² Department of Surgery, Section of Vascular and Endovascular Surgery, Trinity Health Ann Arbor.
³ Piedmont Heart Institute, Section of Vascular and Endovascular Surgery, Piedmont Atlanta Hospital.

PMID: 40582461
DOI: 10.1016/j.avsg.2025.06.028

Abstract

Objective: Iliofemoral peripheral arterial disease is contemporarily managed via endovascular approaches and groin cutdown given the morbidity associated with open surgical reconstructions. However, endovascular reconstruction is afflicted with high rates of restenosis. Our group has previously shown hybrid-based retrograde iliofemoral endarterectomy is safe, efficacious, and yields excellent outcomes at 1 to 2 years. This study aims to show ongoing outcomes at five years or greater.

Methods: This study is a single-institution, retrospective review of 125 hybrid-based, retrograde iliofemoral endarterectomies from January 1, 2010 to November 1, 2022. Data collected from electronic medical records was analyzed using standard quantitative statistical techniques. The primary outcomes were mortality and freedom from major amputation. Secondary outcomes included patency rates, and changes in ankle-brachial index (ABI) and toe pressures.

Results: A total of 125 limbs in 111 patients were included in this study. 57% presented with critical limb ischemia. 97% of patients had TASC II C or D lesions. Average length of follow-up was 29 ± 32 months (range 0 - 125 months). Freedom from major amputation was 98% and primary patency rate was 90% at last follow-up. ABIs improved from 0.43±0.19 to 0.74±0.23 (p<0.01), and toe pressures from 32±23mmHg to 65±32 mmHg (p<0.01).

Conclusions: Hybrid-based, retrograde iliofemoral endarterectomy is a safe and efficacious treatment option for patients with severe iliofemoral occlusive disease. It provides excellent long-term primary patency, and improvement in ABI. This technique should be considered during femoral endarterectomy with external/common iliac reconstruction as a means of achieving minimally-invasive, durable long-term patency.

Keywords: endarterectomy; external iliac; hybrid; iliac disease; iliofemoral.