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Complete occlusion of the infrarenal abdominal aorta: management and results in 64 patients
Insights
Surgical repair of infrarenal abdominal aortic occlusion using thromboendarterectomy and bypass grafts showed a low hospital mortality rate. Long-term follow-up revealed bypass graft limb occlusion and recurrent symptoms due to progressive atherosclerosis.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Outcomes
Background:
- Complete occlusion of the infrarenal abdominal aorta presents significant surgical challenges.
- Effective management strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To review clinical findings, diagnostic procedures, and surgical management of infrarenal abdominal aortic occlusion.
- To evaluate the efficacy and long-term outcomes of thromboendarterectomy and bypass grafting.
Main Methods:
- Retrospective review of 64 patients with complete infrarenal abdominal aortic occlusion.
- Surgical interventions included thromboendarterectomy with bypass grafts, patch graft angioplasty, and modified proximal anastomoses.
- Follow-up data were collected for hospital mortality and late outcomes.
Main Results:
- A hospital mortality rate of 4.6% was observed.
- Sixty-one patients underwent thromboendarterectomy and bypass grafting.
- Late mortality was 4.9%, with complications including bypass graft limb occlusion and recurrent lower extremity vascular insufficiency due to progressive atherosclerosis.
Conclusions:
- Thromboendarterectomy and bypass grafting are effective treatments for infrarenal abdominal aortic occlusion with acceptable mortality rates.
- Long-term management requires addressing progressive distal atherosclerotic disease.
Abstract:
Sixty-four patients with complete occlusion of the infrarenal abdominal aorta were reviewed. The clinical findings, diagnostic procedures, and surgical management are described. Sixty-one patients underwent thromboendarterectomy and bypass grafts from the infrarenal abdominal aorta to the iliac or common femoral arteries. Because purulent material was found in the retroperitoneum of two patients, the proximal anastomosis was performed to the descending thoracic aorta in one patient and to the upper abdominal aorta in the other. One patient underwent thromboendarterectomy and patch graft angioplasty. The hospital mortality rate was 4.6 percent. Sixty-one patients discharged from the hospital were followed (average length of follow-up was 37 months). There were three late deaths (4.9 percent). Two patients have had occlusion of one limb of their bypass grafts and, along with four others, have developed recurrent symptoms of vascular insufficiency of the lower extremities. These symptoms were due to progressive atherosclerotic occlusive disease of the distal arterial tree for which additional distal procedures were required.