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

V Makaloski; L Ilcheva; S Valcheva-Ilieva; M Darwish; D Kotelis; T R Wyss

doi:10.1016/j.avsg.2025.03.007

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

Ann Vasc Surg. 2025 Jul:116:9-16. doi: 10.1016/j.avsg.2025.03.007. Epub 2025 Mar 24.

Authors

V Makaloski¹, L Ilcheva², S Valcheva-Ilieva², M Darwish³, D Kotelis², T R Wyss⁴

Affiliations

¹ Department of Vascular Surgery, Inselspital, Bern University hospital, University of Bern, Bern, Switzerland. Electronic address: vladimir.makaloski@insel.ch.
² Department of Vascular Surgery, Inselspital, Bern University hospital, University of Bern, Bern, Switzerland.
³ Health Education England, East Midlands Deanery, Nottingham, UK.
⁴ Department of Vascular Surgery, Inselspital, Bern University hospital, University of Bern, Bern, Switzerland; Kantonsspital Winterthur, Department of Interventional Radiology and Vascular Surgery, Winterthur, Switzerland.

PMID: 40139429
DOI: 10.1016/j.avsg.2025.03.007

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.

MeSH terms

Aged
Aortic Diseases* / diagnostic imaging
Aortic Diseases* / mortality
Aortic Diseases* / physiopathology
Aortic Diseases* / surgery
Arterial Occlusive Diseases* / diagnostic imaging
Arterial Occlusive Diseases* / mortality
Arterial Occlusive Diseases* / physiopathology
Arterial Occlusive Diseases* / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Blood Vessel Prosthesis Implantation* / mortality
Endovascular Procedures* / adverse effects
Endovascular Procedures* / mortality
Female
Humans
Iliac Artery* / diagnostic imaging
Iliac Artery* / physiopathology
Iliac Artery* / surgery
Limb Salvage
Male
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Vascular Patency