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[Aortofemoral bypass: gold-standard or outdated?]
1Clinique Sarrus-Teinturiers, 49 Allée Charles de Fitte, 31076 Toulouse. j.cron@wanadoo.fr
Insights
Aorto-bifemoral bypass for aortoiliac occlusion is safe, with complications rarely leading to death or amputation. This procedure remains a benchmark for evaluating new revascularization methods.
Area of Science:
- Vascular Surgery
- Surgical Outcomes
- Medical Device Complications
Context:
- Aortoiliac occlusion necessitates surgical intervention, with aorto-bifemoral bypass historically being a primary treatment.
- Minimally invasive techniques are increasingly preferred, necessitating a clear understanding of aorto-bifemoral bypass morbidity.
- This study evaluates complications in a large cohort undergoing aorto-bifemoral bypass by a single surgical team.
Purpose:
- To analyze the incidence and course of complications following aorto-bifemoral bypass surgery.
- To assess the impact of prosthesis-related complications on patient mortality and limb salvage.
- To establish the safety profile of aorto-bifemoral bypass in the context of evolving treatment strategies.
Summary:
- 720 patients underwent aorto-bifemoral bypass for occlusion between 1975-1996, with a mean follow-up of 9.6 years.
- Prosthesis complications occurred in 21.3% of patients, including infections, aneurysms, thrombosis, and strictures.
- Complications led to death in 1.2% and amputation in 3.2% of patients, with late mortality attributed to the prosthesis being minimal.
Impact:
- Despite numerous late complications, aorto-bifemoral bypass demonstrates a limited impact on overall mortality and amputation rates.
- The study reinforces aorto-bifemoral bypass as a safe and reliable procedure.
- It serves as a critical gold standard for comparing the outcomes of alternative revascularization techniques for aortoiliac occlusion.
Abstract:
Although aorto-bifemoral bypass procedures have proven efficacy for the treatment of aortoiliac occlusion, complications have led to a preference for less invasive interventions. A precise knowledge of this morbidity is thus necessary to evaluate and compare outcome with alternative techniques. The purpose of this study was to analyze the course of complications observed in a large group of patients who recently underwent aorto-bifemoral bypass performed by the same team. Between 1975 and 1996, 720 patients underwent aorto-bifemoral bypass procedures for occlusion. Indication for surgery was invalidating claudication in 68%, pain at rest in 28% and trophic disorders in 4%. Mean follow-up was 9.6 years. Twenty-three patients were lost to follow-up. One hundred sixty cases of prosthesis complications were recorded (21.3% of patients): ten infections (1.3%), 14 false aortic aneurysms (2%), 40 false femoral aneurysms (5.5%), 82 prosthetic thrombotic events (11.2%), and 14 femoral anastomotic strictures (1.9%). These complications led to death in nine patients (1.2%) and amputation in 23 (3.2%). Analysis of the results show that late mortality attributable to the prosthesis was minimal compare with other causes of death. Numerous complications occur late after prosthetic repair but their impact on mortality and amputations is limited. Aorto-bifemoral bypass is a safe technique that remains the gold standard for evaluation of other revascularization methods.
