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Long-term graft occlusion in aortobifemoral position
Novak Vasić1, Lazar Davidović, Dragan Marković
1Clinic for Special Surgical Skills, Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina.
Insights
Long-term aortobifemoral bypass occlusion is often caused by issues at the distal anastomosis. Thrombectomy with distal anastomosis patch plasty has the highest failure rate, while other methods show better graft patency.
Area of Science:
- Vascular Surgery
- Surgical Complications
- Graft Patency
Background:
- Aortobifemoral (AFF) bypass is a primary treatment for aortoiliac occlusive disease.
- Long-term graft occlusion is a significant complication of AFF bypass procedures.
Purpose of the Study:
- To identify the causes of long-term aortobifemoral bypass occlusion.
- To evaluate the effectiveness of early treatment strategies for graft occlusion.
Main Methods:
- Retrospective study of 100 patients with long-term bifurcated Dacron graft occlusion.
- Analysis of graft occlusion causes and treatment outcomes.
- Comparison of different surgical revision techniques.
Main Results:
- Distal anastomosis issues were the most frequent cause of long-term occlusion (p = 0.0001).
- End-to-end proximal anastomosis was linked to higher occlusion rates (p = 0.0278).
- Thrombectomy with distal anastomosis patch plasty had the highest failure rate (p = 0.0028), with 87% primary early patency.
Conclusions:
- Optimal AFF bypass patency can be achieved with proximal end-to-end juxtarenal aortic anastomosis.
- Distal anastomosis on the common femoral or deep femoral artery bifurcation is recommended.
- Successful limb salvage rates of 90% were observed after secondary procedures.
Background/Aim:
Aortobifemoral (AFF) bypass is still the most common surgical procedure used in treatment of aortoiliac occlusive disease. One of the most common complications of AFF bypass procedure is long-term graft oclussion. The aim of this study was to determine the cause of long-term graft occlusion in AFF position, as well as the results of early treatment of this complication.
Methods:
This retrospective study, performed at the Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia in Belgrade, involved 100 patients treated for long-term occlusion of bifurcated Dacron graft which was ensued at least one year after the primary surgical pro cedure.
Results:
The most common cause of the long-term graft occlusion was the process at the level of distal anastomosis or below it (Z = 3.8, p = 0.0001). End-to-end type of proximal anastomosis has been associated with a significantly increased rate of long-term graft occlusion (Z = 2.2, p = 0.0278). Five different procedures were used for the treatment of long-term graft occlusion: thrombectomy and distal anastomosis patch plasty (46% of the cases); thrombectomy and elongation (26% of the cases); thrombectomy and femoropopliteal bypass (24% of the cases); crossover bypass (2% of the cases) and a new AFF bypass (2% of the cases). The primary early graft patency was 87%. All 13 early occlusions occurred after the thrombectomy associated with patch plasty of distal anastomosis. Thrombectomy with distal anastomosis patch plasty showed a statistically highest percentage of failures in comparison to thrombectomy with graft elongation, or thrombectomy with femoro-popliteal bypass (Z = 2 984, p = 0.0028). Redo procedures were performed in all the cases of early occlusions. In a 30-day follow-up period after the secondary surgery, 90 (90%) patients had their limbs saved, and above knee amputation was made in 10 (10%) patients.
Conclusion:
Long-term AFF bypass patency can be obtained by proximal end-to-end anastomosis on the juxtarenal part of aorta and distal anastomosis on the bifurcation of the common femoral, or on the deep femoral artery.
