Optimal grafting methods for the small abdominal aorta

Aortobifemoral bypass procedures were performed on 42 patients with the hypoplastic aortoiliac syndrome over an eight year period. During the first five years, 22 patients had either a 13 X 6.5 mm or a 14 X 7 mm knitted Dacron graft and served as historic controls for a second group of 20 others who had 14 X 7 mm grafts of expanded polytetrafluoroethylene (PTFE), during the last three years of the study. Although the two groups were neither concurrent nor randomized, they were nonetheless well matched with regard to age, sex, risk factors, indications for operations, distribution and severity of distal occlusive disease, and type of distal anastomosis. There was only one early graft limb occlusion in the PTFE group after a median follow-up of 14 months, compared to nine occlusions and one amputation in the Dacron group after a median follow-up of 26.2 months. The cumulative patency of the PTFE grafts was 95% at four years compared to only 52% for Dacron (p = 0.11). If the single postoperative occlusion which occurred in each group is excluded, then the difference in patency rates bordered on statistical significance (p = 0.06). Inclusion of the profunda femoris orifice in the distal anastomosis was also found to be an important factor contributing to long-term patency which approached statistical significance (p = 0.075). The configuration of the proximal aortic anastomosis (end to end vs. end to side), or the concomitant use of lumbar sympathectomy or the postoperative infusion of Dextran did not have a statistically significant influence on patency.(ABSTRACT TRUNCATED AT 250 WORDS)