Aorto-iliac thrombo-endarterectomy

A series of 46 patients, all of whom underwent thrombo-endarterectomy for occlusive atherosclerotic disease of the abdominal aorta and iiiac arteries, is presented. The operative mortality of the whole series is 10 per cent but in the last 32 cases only 3 per cent. This compares favourably with other published series and other reconstructive procedures. The follow-up ranges from 6 months to 9 years and averages 2 years 6 months in the 42 postoperative survivors. In this group the patency rate is 90 per cent. The incidence and causation of impotence post-operatively are discussed and measures suggested for avoiding this complication. Emphasis is laid on the anatomical distribution of the atheroma and its haemodynamic effects as determining factors in the prognosis and the suitability of this disease for treatment by thrombo-endarterectomy. Further advance in the operative treatment of atherosclerosis of the great abdominal vessels should continue to take an ever-increasing account of the perfusion and flow problems intimately associated with the disease and its relief.