BACKGROUND Historically, the treatment of iliac artery occlusive disease required a surgical bypass usually consisting of an aortobifemoral bypass or an iliofemoral bypass. With the advent of balloon angioplasty and stenting, these procedures are frequently replaced with endovascular options. However, the treatment of diffuse occlusive disease of the external iliac artery (EIA) using balloon angioplasty and/or stenting does not carry a favorable long-term patency rate. Remote endarterectomy of the EIA using ring dissectors with balloon assistance provides a novel, controlled, safe, and durable treatment of the diseased and/or occluded EIA. METHODS A retrospective review over the past 6 years was performed at our institution identifying patients treated with balloon-assisted remote endarterectomy of the EIA by the current five practicing vascular surgeons. The technique involves exposure of the ipsilateral common femoral artery. With nonocclusive disease, direct access into the common femoral artery is performed, a wire is traversed through the diseased EIA, and a balloon is inflated at the origin of the vessel providing hemostasis and control. A femoral endarterectomy is performed, and a ring dissector is passed over the endarterectomized material including the wire and balloon catheter and advanced remotely through the EIA up to the balloon. The balloon is briefly deflated, repositioned within the ring dissector, and reinflated, thus cutting the plaque. This allows for retraction of the inflated balloon and cutter, removing the endarterectomized core plaque. The procedure is similar for the treatment of an occluded EIA, but wire access across the occluded vessel is normally achieved with contralateral access. In both cases, the balloon provides control and hemostasis and is critically important in the rare treatment of vessel rupture. RESULTS A total of 101 vessels were treated in 97 patients. The procedure was successful in 98 vessels (97%) with failure related to vessel rupture requiring conversion to an iliofemoral bypass. The estimated patency rate at three years was 94% with a median follow-up of 20 months. Restenosis/occlusion in four patients seemed to be related to a severe sclerotic response. The EIA was occluded 32% of the time. The common iliac artery (CIA) was diseased requiring angioplasty and stenting 29% of the time and a stent was placed at the transition zone between endarterectomized vessel and nontreated proximal most EIA or distal most CIA 58% of the time. There were no perioperative deaths. CONCLUSIONS Balloon-assisted remote endarterectomy of the diffusely diseased and/or occluded EIA is a safe and durable option. It precludes the need for a prosthetic conduit and the risk of associated infection. It also involves a single groin incision and negates the need for retroperitoneal exposure of the CIA.

中文翻译：

---

气囊辅助远程remote外动脉内膜切除术：一种安全，耐用的技术，用于治疗ilia动脉闭塞性疾病。

背景技术历史上，the动脉闭塞性疾病的治疗需要外科手术旁路，该手术旁路通常包括主动脉经股旁路或an股旁路。随着球囊血管成形术和支架的出现，这些程序经常被血管内替代。但是，使用球囊血管成形术和/或支架置入术治疗外弥漫性闭塞性疾病并不能带来良好的长期通畅率。使用环解剖器和球囊辅助对EIA进行远端内膜切除术，可为病变和/或闭塞的EIA提供新颖，可控，安全和持久的治疗方法。方法在过去的6年中，我们的机构进行了一项回顾性研究，确定了目前有5位执业的血管外科医师对接受EIA气囊辅助远端内膜切除术治疗的患者。该技术涉及暴露同侧股总动脉。对于非闭塞性疾病，将直接进入股总动脉，将一根导线穿过患病的EIA，并在血管起点处膨胀一个球囊以提供止血和控制作用。进行股动脉内膜切除术，然后将环形解剖器穿过包括金属丝和球囊导管的内膜切除材料，并通过EIA远距离推进至球囊。将球囊短暂放气，重新放置在环解剖器内，然后重新充气，从而切开斑块。这可以使膨胀的球囊和切割器缩回，从而去除内动脉切开的核心斑块。闭塞EIA的治疗过程相似，但通常通过对侧通路可实现跨闭塞血管的导线进入。在这两种情况下，球囊均可提供控制和止血功能，在罕见的血管破裂治疗中至关重要。结果共治疗101例血管，共97例患者。该手术在98例血管中成功（97％），与血管破裂相关的失败需要转换为股旁路。三年的估计通畅率为94％，中位随访时间为20个月。四名患者的再狭窄/闭塞似乎与严重的硬化反应有关。EIA被阻塞32％的时间。总动脉（CIA）患病需要29％的时间进行血管成形术和支架置入术，并且58％的时间将支架放置在动脉内切开血管和未治疗的最远端EIA或最远端CIA之间的过渡区。没有围手术期死亡。结论弥漫性疾病和/或闭塞性EIA的球囊辅助远端内膜切除术是一种安全，耐用的选择。它排除了假体导管的需要和相关感染的风险。它也只涉及一个腹股沟切口，因此不需要CIA腹膜后暴露。结论弥漫性疾病和/或闭塞性EIA的球囊辅助远端内膜切除术是一种安全，耐用的选择。它排除了对假体导管的需求以及相关感染的风险。它也只涉及一个腹股沟切口，因此不需要CIA腹膜后暴露。结论弥漫性疾病和/或闭塞性EIA的球囊辅助远端内膜切除术是一种安全，耐用的选择。它排除了对假体导管的需求以及相关感染的风险。它也只涉及一个腹股沟切口，因此不需要CIA腹膜后暴露。