Examples of Suprainguinal Vascular Surgery
Suprainguinal vascular surgery refers to procedures performed on the aorta and iliac arteries above the level of the inguinal ligament, including open aortic aneurysm repair, aortoiliac bypass, and endovascular interventions on these vessels. 1
Common Suprainguinal Vascular Procedures
Open Surgical Procedures
- Aortic aneurysm repair: Open repair of infrarenal abdominal aortic aneurysms (AAAs) and common iliac aneurysms 1
- Aortoiliac bypass: Surgical reconstruction for aortoiliac occlusive disease 1
- Suprainguinal arterial reconstruction: Direct surgical revascularization of the aorta and iliac vessels 2
- Renal and visceral arterial reconstruction: Open surgical repair of renal or mesenteric arteries originating from the suprainguinal aorta 2
Endovascular Procedures
- Endovascular aortic aneurysm repair (EVAR): Less invasive approach for treating abdominal aortic aneurysms 1
- Suprainguinal percutaneous transluminal angioplasty/stent (PTA/S): Endovascular treatment of aortoiliac occlusive disease 2
- Renal and visceral PTA/S: Endovascular interventions for renal or mesenteric artery stenosis 2
Clinical Significance
Suprainguinal vascular procedures are specifically identified in perioperative risk assessment tools like the Revised Cardiac Risk Index (RCRI), which considers "undergoing suprainguinal vascular, intraperitoneal, or intrathoracic surgery" as one of six predictors of major cardiac complications 1.
These procedures are generally associated with higher perioperative risk compared to infrainguinal (below the inguinal ligament) interventions. The 2014 ACC/AHA guidelines specifically note that "operations for peripheral vascular disease are generally performed among those with the highest perioperative risk" 1.
Changing Practice Patterns
There has been a significant shift in practice patterns over time:
- Open suprainguinal procedures have decreased by approximately 47.5% in some academic centers 2
- Endovascular approaches have increased dramatically (by over 600% in some centers) 2
- This shift reflects technological advances and improved outcomes with less invasive approaches 1
Age Considerations
Recent research indicates that age may influence outcomes for suprainguinal interventions:
- Younger patients (<60 years) may have better outcomes with open surgical procedures for suprainguinal disease 3
- Older patients (≥60 years) may benefit more from endovascular interventions due to reduced perioperative mortality 3
Surveillance After Intervention
Unlike infrainguinal bypass grafts that require regular duplex ultrasound surveillance, suprainguinal bypass grafts have superior durability and do not typically require the same intensive surveillance protocol 1.
Medical Management
Optimal medical management with both antiplatelet and statin therapy is crucial for patients undergoing suprainguinal vascular surgery, as it has been associated with reduced 30-day mortality and improved 5-year survival 4.
Suprainguinal vascular surgery represents a critical category of vascular interventions with significant implications for perioperative risk assessment and management strategies.