"Endarterectomy revisited": Langzeitergebnisse nach aorto-iliakaler Desobliteration mit der "Arterial Disobliteration Device" (Plaque-cracker). Eine 7-Jahres-Nachkontrolle

In 1973 LeVeen et al. described a new technique for extensive, retroperitoneal disobliteration of the aorto-bifemoral tract using the arterial disobliteration device (ADD). In Europe this technique was first described in 1981 by Widdershoven and Willekens. Later on more publications from Spain, Poland, Belgium and the Netherlands appeared. At the Groot Ziekengasthuis in 's-Hertogenbosch (the Netherlands) the new procedure was introduced in 1984. Until 1991, 158 patients were operated. The results were analysed. The average follow-up time was 44 months (range 3-84). In 44.5% of these patients intermittent claudication was the reason for operation. In 40.5% of the cases there was untreatable ischemic rest pain and in 15% there was also ischemic gangrene of one or both legs. Aorto-bi-iliac disobliteration was performed in 55 patients, aorto-bi-femoral disobliteration in 31 patients and unilateral disobliteration in another 48 patients. In 24 patients we performed an unilateral aorto-femoral with a contralateral aorto-iliac desobstruction. Both the operation technique and the results are described. Five patients died in the early postoperative period and in 16 patients early reintervention i.e. within 6 hours after the initial operation was necessary for hemorrhage or acute vascular occlusion. During the follow-up 15 patients died. Recurrent occlusion was seen six times while in two patients restenosis developed. In conclusion; in selected patients with aorto-femoral occlusive disease the ADD-procedure can replace the up to now usual procedures