Summary
For aortoiliac occlusive disease, aortofemoral grafts are now preferred over endarterectomy due to lower mortality and improved long-term patency. Specific graft techniques enhance success, making direct reconstructions rarely indicated.
Area of Science:
- Vascular Surgery
- Surgical Reconstruction
- Aortoiliac Occlusive Disease Management
Background:
- Aortoiliac occlusive disease necessitates surgical intervention for limb salvage and improved quality of life.
- Historical surgical approaches included endarterectomy and bypass grafting, with evolving techniques and outcomes.
Purpose of the Study:
- To review and compare outcomes of alternate aortic reconstruction methods for aortoiliac occlusive disease.
- To identify trends in surgical approaches and evaluate their effectiveness over a 15-year period.
Main Methods:
- Retrospective analysis of a personal series of 582 patients (1,105 limbs) undergoing aortic reconstruction from 1963 to 1977.
- Data stratified into two intervals: 1963-1969 (Interval I) and 1970-1977 (Interval II) to assess trends.
- Comparison of endarterectomy versus graft procedures, focusing on mortality, early failure, and long-term patency.
Main Results:
- Shift from endarterectomy (72% in Interval I) to graft procedures (89% in Interval II).
- Significant reduction in operative mortality (5.1% to 2%) and early failure (<4% to <1%) with graft use.
- Five-year patency for aortofemoral grafts reached 91% in the later period, associated with specific anastomotic techniques and Dacron prosthesis.
Conclusions:
- Aortofemoral grafts are the preferred procedure for extensive aortoiliac occlusive disease, offering superior long-term outcomes.
- Aortoiliac endarterectomy remains suitable for a small subset of patients with localized disease.
- Low complication rates (infection 0.3%, false aneurysm 1.4%) support direct reconstruction, with extraterritorial grafts rarely indicated.
