Disobliteration of the aorto-iliac (-femoral) arteries with the plaque cracker, using the retroperitoneal approach

The aorto-iliac disobliteration technique using the LeVeen plaque cracker is described and the results in 70 patients (operated on at the Elisabeth Hospital, Sluiskil, The Netherlands), are presented. The early mortality rate for the series was 4.3%. There were two cases of haemorrhage due to adventitial damage, within two weeks of the operation. The 5 year patency rate was 100%. The LeVeen disobliteration technique is a considerable improvement in the conventional open or half closed endarterectomy. The operation is shorter, and simpler. Also it is ideally suited for combination with the retroperitoneal approach. The technique can be easily combined with disobliterations distal to the groin. The relative advantages and disadvantages of the closed disobliteration and synthetic graft methods are discussed together with the reasons why the closed disobliteration technique seems to be the method of choice in those patients without aneurysms or excessive calcification.