Surgery recommended for severely
blocked or narrowed iliac arteries

Aortoiliac occlusive disease (AIOD), a disorder of the circulatory system that occurs when the iliac arteries narrow or become blocked, greatly affects a per son’s quality of life. Its effects range from discomfort to pain throughout the lower body, depending on the stage of the disease. Vascular surgeons have not been in agreement on the optimal treatment. The authors of an article in the current issue of the Journal of Endovascular Therapy analyzed many studies to decide which of two options, open bypass surgery or endovascular repair is preferable for treating severe cases of the disease.
Open bypass surgery allows surgeons to access regions of the body through major blood vessels. Because this option is more invasive, surgeons are increasingly attempting less invasive endovascular repair for patients with AIOD. Recent advances in technology make endovascular repair relatively safe. However, the authors of the current article say this trend is controversial.
The authors analyzed the most recent data in their attempt to recommend the preferable AIOD treatment. They searched several databases and found nearly 60 relevant studies published from 1989 to 2010 that included more than 5,300 patients. Mean patient age was around 60 years whether the patient was treated surgically or endovascularly.
The authors concluded that AIOD should be tackled through surgery because 5 years after treatment, patients who had undergone surgery had fewer issues with blocked lower-body arteries. The authors contend that this outcome overrides other findings, such as patients in the open bypass group spending more time in the hospital, having more complications, and dying more frequently within the first month compared with those in the endovascular treatment group.
The authors of a commentary in the same issue of the journal agreed with the conclusions that surgery is a higher risk, requires more hospital time, and costs more initially, yet produces better long-term results compared with the endovascular method. However, they emphasize that endovascular repair should remain a possible treatment for this disease. They call the two options complementary and synergic tools and suggest that surgeons offer both to their patients, basing their recommendation on what is best for each patient.(PR)

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