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Extra-anatomical grafting for aorto-occlusive disease: the outcome in 133 procedures
H Schroe1, A Nevelsteen, R Suy
1Department of Vascular Surgery, U.Z. Gasthuisberg, Leuven.
Insights
Extra-anatomical bypass grafts for aorto-iliac occlusive disease show lower patency and limb salvage rates than direct grafting. Cross-over grafts are suitable for unilateral disease, while axillofemoral grafts are best for high-risk limb salvage.
Area of Science:
- Vascular Surgery
- Cardiovascular Surgery
- Reconstructive Surgery
Background:
- Aorto-iliac occlusive disease (AIOD) necessitates surgical intervention.
- Extra-anatomical bypass grafting offers an alternative when direct reconstruction is not feasible.
- Understanding the outcomes of different extra-anatomical bypass techniques is crucial for patient selection.
Purpose of the Study:
- To evaluate the outcomes of extra-anatomical bypass grafts for AIOD.
- To compare the efficacy of cross-over, axillofemoral, and axillobifemoral grafts.
- To determine the long-term patency and limb salvage rates.
Main Methods:
- Retrospective analysis of 133 extra-anatomical grafts (1978-1988).
- Graft types included cross-over, axillofemoral, and axillobifemoral.
- Indications: acute ischemia, claudication, and limb salvage.
- Follow-up averaged 32 months.
Main Results:
- Perioperative mortality was 10.4%.
- 3-year patency rates: 78% (cross-over) and 49% (axillofemoral).
- 3-year limb salvage rates: 89% (cross-over) and 75% (axillofemoral).
- Cardiovascular complications accounted for 54% of late deaths.
Conclusions:
- Extra-anatomical grafts have less favorable outcomes than direct aortofemoral grafting.
- Cross-over grafts are recommended for unilateral AIOD.
- Axillofemoral grafts should be reserved for high-risk limb salvage procedures.
Abstract:
Between 1978 and 1988 133 extra-anatomical grafts were performed in patients presenting with aorto-iliac occlusive disease. These series include 50 cross-over grafts, 46 axillofemoral and 37 axillobifemoral grafts. The indication for operation was acute ischemia in 26.4%, claudication in 9.7% and limb salvage in 63.9% of cases. Perioperative mortality rate was 10.4%. The early patency rate decreased from 92% after cross-over grafting to 86% in the axillofemoral series and 8% of the patients needed a major amputation in the immediate postoperative period. With a mean follow-up of 32 months, 62% of the patients died within 5 years of the operation, 54% of deaths being due to cardiovascular complications. The 3-years patency rate decreased to 78% after cross-over grafting and 49% after axillofemoral grafting. The 3-year limb salvage rate decreased to 89% and 75% respectively. Although our results are definitely less favourable than those of direct aortofemoral grafting, they seem to support the further use of the cross-over graft in patients with unilateral occlusive disease. Axillofemoral grafting on the other hand should be preserved for limb saving reconstructions in high risk conditions.