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Published on: May 14, 2013
An algorithm for the surgical management of chronic abdominal aortic occlusion and occluded aortofemoral grafts
D E Bowes1, J R Youkey, D P Franklin
1Department of Cardiovascular Surgery, Geisinger Medical Center, Danville, PA 17822-1343.
Insights
This study presents a surgical algorithm for chronic aortic occlusion, detailing bypass graft choices and outcomes. Aortofemoral bypass showed the highest 5-year graft patency, while descending thoracic aortofemoral bypass had the lowest perioperative mortality.
Area of Science:
- Vascular Surgery
- Surgical Management
- Aortic Occlusion
Background:
- Chronic aortic occlusion presents complex surgical challenges.
- Selecting the appropriate bypass strategy is crucial for patient outcomes.
- Previous management algorithms lacked comprehensive outcome data.
Purpose of the Study:
- To present a surgical management algorithm for chronic aortic occlusion.
- To analyze the outcomes of different bypass procedures in a consecutive patient cohort.
- To guide surgical decision-making for juxtarenal, mid/distal aortic, and aortic graft occlusions.
Main Methods:
- Retrospective analysis of 60 consecutive patients with chronic aortic occlusion.
- Categorization of occlusions into juxtarenal, mid/distal, and graft occlusion.
- Surgical intervention included aortofemoral bypass (AFB), descending thoracic aortofemoral (DTAF), and axillofemoral (AxF) bypass.
- Evaluation of perioperative mortality, late mortality, and 5-year graft patency.
Main Results:
- Aortofemoral bypass (AFB) was used in 26 patients, descending thoracic aortofemoral (DTAF) in 22, and axillofemoral (AxF) in 11.
- DTAF was preferred for graft occlusions and hazardous intraabdominal pathology.
- AxF was reserved for high-risk patients or limb salvage.
- 5-year graft patency: AFB 92%, DTAF 89%, AxF 15%. Perioperative mortality: AFB 8%, DTAF 5%, AxF 36%.
Conclusions:
- The presented algorithm effectively stratifies patients for surgical management of chronic aortic occlusion.
- Aortofemoral bypass offers excellent long-term patency for suitable candidates.
- Descending thoracic aortofemoral bypass is a viable option for complex cases, while axillofemoral bypass serves a critical role in high-risk limb salvage scenarios.
Abstract:
An algorithm for the surgical management of chronic abdominal aortic occlusion is presented based upon experience of treating 60 consecutive patients. Of 33 patients with juxtarenal aortic occlusion, 17 underwent aortofemoral bypass (AFB), 10 descending thoracic aortofemoral (DTAF), 5 axillofemoral (AxF) bypass, and 1 ascending thoracic aortofemoral bypass. Of 11 patients with mid or distal aortic occlusion, 8 underwent AFB, 2 DTAF and 1 AxF. Of 16 patients with aortic graft occlusion, 1 underwent AFB, 10 DTAF and 5 AxF. Acceptable risk patients were selected for AFB (26). DTAF (22) was frequently preferred for patients with occluded aortic grafts or other hazardous intraabdominal pathology. AxF (11) was used for patients with severe cardiopulmonary risk, limited life expectancy from malignancy, or when emergency procedures were required for salvage of severely ischemic limbs in debilitated patients with chronic aortic occlusion. In the AFB, DTAF and AxF groups the perioperative mortality was 8%, 5% and 36% respectively, the late mortality was 15%, 36% and 45%, and the 5-year primary cumulative graft patency was 92%, 89% and 15%.
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