[Anatomical and extra-anatomical reconstructions in aorto-iliac occlusive diseases]

In the case of the aorto-iliac arteries occlusion there are two different operative reconstructive possibilities. As an anatomical reconstruction the open desobliteration of the iliaca arteries, the retrograde half-closed desobliteration or the aorto/ilio-femoral bypasses can be mentioned. As an extraanatomical solution ilio/femoro-femoral crossover bypass can be implanted. We compared the results of these two types of operations.

Between 1 January 1998 and 31 December 1999 at the Cardiovascular Surgical Department of the Semmelweis University Budapest 239 primary, reconstructive operations were done because of the iliac arteries occlusion. We made 175 anatomical and 64 extraanatomical operations. We controlled the results of this operation in this retrospective study.

Since the operation 12 patients died, most of them because of cardial reasons. Hundred sixty seven survival patients could be involved in the study. There was no significant difference regarding the age and the Fontaine stadium of the patients in the two groups. Two-third of the patients underwent anatomical, the others extraanatomical operations. The patency rate in the anatomical group was 92.8%, with the extraanatomical patients 90%. In the view of the postoperative function after the anatomical reconstruction the claudication distance was longer. There were two limb amputations, one of them because of distal progression of the atherosclerosis, in the other case the reason was reocclusion of the graft.

In this study we examined patients who underwent an operation about 3 years ago. The preoperative stadium of the two non-selected groups was similar. The postoperative patency rate was quite similar, but the postoperative function after the anatomical reconstruction was significantly better. In our opinion the results of the two different types of the reconstruction used by proper indication were the similarly satisfactory.