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

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.