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Occlusion of aortofemoral bifurcation grafts: how to improve the results?
1Department of Surgery, Universitätsklinikum Rudolf Virchow, Standort Charlottenburg, Free University, Berlin, Germany.
Insights
Late graft occlusion after aortofemoral bypass surgery is common, often due to poor outflow or reduced inflow. Technical improvements in proximal anastomosis may reduce bifurcation graft occlusions.
Area of Science:
- Vascular Surgery
- Graft Patency
- Aortofemoral Bypass
Background:
- Graft occlusion following aortofemoral bypass surgery presents significant challenges.
- Late occlusions are a predominant issue, impacting long-term graft patency.
Purpose of the Study:
- To analyze the causes and outcomes of graft occlusion after aortofemoral bifurcation bypass.
- To identify factors contributing to graft failure and evaluate management strategies.
Main Methods:
- Retrospective analysis of 43 patients with graft occlusion after aortofemoral bifurcation bypass surgery (1971-1986).
- Evaluation of 52 bypass branches and 75 graft occlusions, focusing on reasons for failure and surgical interventions.
Main Results:
- Late occlusion accounted for 73.1% of graft failures.
- Poor run-off (40.4%) and reduced inflow (36.6%), often due to graft kinking, were primary causes.
- Perioperative mortality was 13.9%; 20.9% of patients could not be saved, with major amputation necessary in four cases.
Conclusions:
- Graft occlusion, particularly late occlusion, remains a critical complication of aortofemoral bypass.
- Addressing technical aspects of the proximal anastomosis is recommended to potentially reduce the incidence of bifurcation graft occlusions.
Abstract:
Forty-three patients with graft occlusion after aortofemoral bifurcation bypass surgery were analysed (1971-1986, 52 bypass branches, 75 graft occlusions). The late occlusion dominated with 73.1%. A poor run off was the main reason in 40.4%. A reduced inflow was responsible in 36.6%, especially caused by graft kinking. Bypass thrombectomy was performed in 56.7%, in 35.8% in combination with a distal reconstruction. Graft exchange was indicated in 39.6% but in 25.6% extraanatomical reconstruction was performed due to a high risk situation. Perioperative mortality rate measured 13.9%, not depending on the surgical procedures. Four times a major amputation was unavoidable. Therefore, in nine patients (= 20.9%) extremity or life could not be preserved. The rate of bifurcation graft occlusions can be reduced by technical improvement of the proximal anastomosis as to the mentioned guidelines.