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Long-term outcome of aortofemoral bypass for aortoiliac occlusive disease
1Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, SAR China. hklauh@netscape.net
Insights
Aortofemoral bypass shows excellent long-term results for aortoiliac occlusive disease, with 89% primary patency at 5 years and a satisfactory limb salvage rate, making it a preferred treatment.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
- Surgical Outcomes
Background:
- Aortoiliac occlusive disease treatment has evolved.
- Tertiary vascular centers are key in managing complex cases.
- Long-term outcomes of revascularization are critical.
Purpose of the Study:
- Evaluate long-term outcomes of aortofemoral bypass.
- Assess graft patency, complications, limb loss, and survival.
- Compare outcomes for claudication versus limb salvage.
Main Methods:
- Retrospective analysis of 94 patients (176 limbs).
- Focus on survivors of aortofemoral bypass.
- Grouped patients by indication: claudication vs. limb salvage.
Main Results:
- 5-year primary patency rate of 89%.
- Late complications included pseudoaneurysm and infection.
- Limb loss rate was 5.1% at 4 years; 10-year survival was 75%.
Conclusions:
- Aortofemoral bypass offers good patency and limb salvage.
- Preferred for good-risk patients with aortoiliac occlusion/stenosis.
- Outcomes are superior for claudication compared to limb salvage.
Introduction:
Revascularisation of aortoiliac occlusive disease has been evolving in the past 2 decades. The present study was undertaken to evaluate the long-term outcomes of aortofemoral bypass for aortoiliac occlusive disease at a tertiary vascular disease centre in Hong Kong.
Materials And Methods:
A retrospective analysis of 94 patients (176 limbs) who survived aortofemoral bypass was performed to evaluate the graft patency, long-term complications, limb loss and patient survival rates. Thirty-six patients were operated for incapacitating claudication (Group I) and 58 for limb salvage (Group II).
Results:
The overall primary patency rates of aortofemoral bypass were 97%, 90%, 89% and 84% at 1, 3, 5 and 10 years, respectively. Poor distal run-off and neointimal hyperplasia were the leading causes of late graft failure. Other late complications included femoral pseudoaneurysm (n = 1), infection (n = 1) and femoral graft aneurysms (n = 2). The limb loss rate was 5.1% at 4 years. The overall survival rates were 95%, 86%, 81% and 75% at 1, 3, 5 and 10 years, respectively. Ischaemic heart disease and malignancy were the 2 major causes of late death. The 5-year survival rate of group I patients (96%) was significantly superior to that of group II patients (70%).
Conclusions:
Aortofemoral bypass achieved a primary patency rate of 89% at 5 years and a satisfactory limb salvage rate. It remains the preferred treatment option for good risk patients with complete occlusion or extensive stenosis of the aortoiliac arteries.
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