The reoperation of choice for aortofemoral graft occlusion

Restoration of circulation following occlusion of an aortofemoral graft was attempted in 50 limbs in 38 patients. Progressive arteriosclerosis in the femoral vessels was the cause of graft limb thrombosis in most instances. Profundaplasty was employed in 47 limbs and femoral-popliteal bypass in two to provide effective runoff. Inflow was established by thrombectomy in 30 of the 37 limbs in which it was attempted, and it was readily accomplished with a Fogarty catheter if carried out within a few weeks after graft occlusion. In the 20 limbs in which thrombectomy was either abandoned (seven or not feasible because of prolonged delay (13), new grafts were inserted (13) or extra-anatomic bypass was carried out by femoral-femoral (four) or axillary-femoral (three) techniques. Operative death occurred in one patient (2.6%) after transabdominal graft replacement, and only two other patients had significant complications with full recovery. Initial graft patency was achieved in 96.6% following thrombectomy and in 85% following new graft or extra-anatomic bypass. Cumulative patency was 75% after 3 years. Amputation was required in five of the limbs in which graft patency could not be maintained. Reoperation should be performed promptly after graft limb thrombosis. The procedure of choice is thrombectomy and profundaplasty through a simple groin incision.