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August 1989

Closed EndarterectomyPreferred Operation for Aortoiliac Occlusive Disease

Author Affiliations

From Elisabeth Hospital, Sluiskil, the Netherlands (Dr Widdershoven), and the Department of Surgery, Medical University of South Carolina, Charleston (Dr LeVeen).

Arch Surg. 1989;124(8):986-990. doi:10.1001/archsurg.1989.01410080122022

• Closed endarterectomy using the LeVeen plaque cracker was performed on isolated, clamped segments of the unopened aorta, iliac, and femoral arteries. The results of this type of endarterectomy have been analyzed for 111 patients who were followed up from 2½ to nine years. The five-year patency rate was 99%. After nine years, 96.5% of the vessels that underwent surgery remained functionally and radiographically patent. Closed endarterectomy is a substantial improvement over conventional open or half-closed endarterectomy. The closed endarterectomy takes less time, entails little or no blood loss, and is accomplished through a retroperitoneal approach. The aortofemoral bypass graft is inferior to the closed endarterectomy in morbidity, mortality, patency, and alleviation of impotence. Late complications with bypass grafts, using synthetic material, are more numerous and lifethreatening.

(Arch Surg 1989;124:986-990)