[Surgical treatment and result of high aortic occlusion]

Twenty-one patients with high aortic occlusion treated at our institution from 1967 to 1986 were reviewed. There were seventeen men aged from 39 to 78 (mean age: 61.0) underwent surgical intervention. All patients presented clinical manifestations of vascular insufficiency of the lower limbs; rest pain in eleven patients, intermittent claudication in nine and the others. Sexual impotence was present in eight patients. Renal artery involvement was seen in one case, and renovascular hypertension was observed in this patient. Hypertension and ischemic heart disease were present in twelve cases, cerebrovascular insufficiency in one case, diabetes mellitus in three cases. The following surgical treatments were performed; end-to-end Y-shaped Dacron graft implantations from the infrarenal abdominal aorta to the common femoral arteries in six patients, onlay V-shaped Dacron graft implantations in three patients, axillofemoral extra-anatomic bypass in four patients, and amputation only in one. The hospital mortality was 18% (3/17). Twelve patients discharged from the hospital are followed up (average period was 118 months), but the follow up was lost in two patients. There were two late deaths, which course was not related to operations. The prognosis of high aortic occlusion after anatomic bypass is good, thus it was concluded that anatomic bypass with Y-shaped or V-shaped Dacron graft was recommended and extra-anatomic bypass might be performed only in a high risk patient.