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Aortofemoral dacron reconstruction for aorto-iliac occlusive disease: a 25-year survey
A Nevelsteen1, L Wouters, R Suy
1Department of Vascular Surgery, University Clinic, Gasthuisberg, Leuven, Belgium.
Insights
This study evaluated aorto(bi)femoral Dacron grafts in 869 patients with peripheral artery disease. Long-term results show moderate survival and graft patency, with functional outcomes influenced by smoking and disease severity.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Outcomes Research
Background:
- Occlusive disease of the aorta and femoro-populi arteries significantly impacts patient morbidity and mortality.
- Aorto(bi)femoral bypass grafting is a common surgical intervention for severe lower extremity ischemia.
Purpose of the Study:
- To assess the long-term efficacy and outcomes of aorto(bi)femoral Dacron grafts in patients with peripheral occlusive disease.
- To identify factors influencing graft patency, patient survival, and functional results after surgery.
Main Methods:
- Retrospective analysis of 869 consecutive patients undergoing aorto(bi)femoral Dacron grafting between 1963 and 1988.
- Data collection included patient demographics, disease severity (grades 1-3), operative mortality, graft patency, amputation rates, and functional outcomes.
- Long-term follow-up assessed survival, graft patency, limb salvage, and functional status, with analysis of secondary and tertiary operations.
Main Results:
- Operative mortality was 4.5%. Median survival was 8.2 years, with 25% surviving over 15 years.
- Late graft patency rates were 74% at 10 years and 70% at 15 years.
- Amputation rates varied by disease grade (3% for grade 1, 8.6% for grade 2, 12.1% for grade 3). Initial functional results were 51% (10 years) and 40% (15 years), improving to 70% and 61% with reoperations.
Conclusions:
- Aorto(bi)femoral Dacron grafts provide durable long-term patency and survival for patients with occlusive disease.
- Postoperative smoking cessation, surgical timing, and absence of concomitant femoro-popliteal disease are critical for optimal long-term functional outcomes.
- Reoperative strategies can significantly improve functional results in patients with failing grafts or limb-threatening ischemia.
Abstract:
The authors present a consecutive series of 869 patients, who received an aorto(bi)femoral Dacron graft for occlusive disease between 1963 and 1988. The operative indications were grade 1 disease (n = 371), grade 2 disease (n = 408) or grade 3 disease (n = 90). The operative mortality was 4.5% and remained stable over the years of the study. The median survival was 8.2 years and 25% of the patients survived for more than 15 years. Late patency decreased to 74% and 70% after 10 and 15 years, respectively. Fifty-six patients underwent a major amputation in the long run. The amputation rate increased to 3, 8.6 and 12.1%, respectively for grade 1, grade 2 and grade 3 disease. Satisfactory functional results were obtained by 51% and 40% of the patients after 10 and 15 years, respectively. By means of secondary and tertiary operations this increased to 70% and 61%. Long term functional results were primarily dependent on smoking habits postoperatively, the date of operation and the presence of concomitant femoro-popliteal occlusive disease.