Severe left internal iliac artery disease, chronic kidney disease, and increasing aortic cross-clamp duration were independently associated with 30-day mortality after open aorto-iliac reconstruction, while intraoperative blood loss was associated with late mortality in exploratory univariate analysis.
Thirty-day mortality after open aorto-iliac reconstruction for aorto-iliac occlusive disease was 9.4% in a cohort of 170 consecutive patients.
Severe left internal iliac artery (IIA) stenosis ≥70% was the strongest factor independently associated with 30-day mortality.
Chronic kidney disease was independently associated with higher 30-day mortality.
Longer aortic cross-clamp duration was independently associated with 30-day mortality, both as a continuous variable and as a ≥60 minute threshold.
Non-inclusion of the internal iliac artery in the reconstruction was associated with higher 30-day mortality on univariate analysis.
Among 30-day survivors, intraoperative blood loss was the only factor significantly associated with late mortality in exploratory univariate Cox regression.
The study's design has limitations that restrict the strength of its conclusions, and the authors call for validation in larger prospective cohorts.
This study looked at 170 patients who had open surgery to rebuild blocked arteries in the aorta and pelvis (aorto-iliac occlusive disease) at one center between 2018 and 2024. About 1 in 11 patients (9.4%) died within 30 days of surgery. The researchers examined which patient and surgical factors were linked to those early deaths. Three factors stood out as independently linked to early death: severe narrowing (70% or more) of the left internal iliac artery, which supplies blood to the pelvis; chronic kidney disease; and longer time with the aorta clamped during surgery. Each additional minute of clamping was associated with slightly higher risk, and clamp times of an hour or more were linked to a bigger increase. Not restoring blood flow to the internal iliac artery was also linked to higher early mortality in a simpler analysis. Among patients who survived the first 30 days, greater blood loss during surgery was associated with a higher chance of dying later, though only 10 late deaths occurred. These findings suggest that pelvic artery disease, kidney function, and operative factors such as clamp time and blood loss may be relevant to risk planning for this type of surgery. However, the study is small, from a single group of patients, and observational, so it cannot show cause and effect. The authors say larger prospective studies with longer and more consistent follow-up are needed to confirm the results.
Imanbayev M, Dyussupov A, Tussupkanov B, Muratzhanov E, Mautbekova A, Kozubayeva D, et al.. (2026). Predictors of Early Mortality After Open Aorto-Iliac Reconstruction in Patients with Aortoiliac Occlusive Disease: An Observational Cohort Study.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62102001