Reoperation within 2 years of aortofemoral bypass

The authors analysed 267 consecutive primary aortofemoral grafts to identify the reasons for reoperation within the first 2 years postoperatively. Forty-one (8%) of the 521 limbs required a second operation. Precursors to reoperation were: occlusion of a superficial femoral artery (12%), gangrene (27%) and severe acute ischemia (35%). The rationale for reoperation was classified as technical 11, questionable selection (candidates for percutaneous transluminal angioplasty or inappropriate operation) 9, disease progress 11, residual symptoms 9, contralateral symptoms 1. The commonest technical problem was blind endarterectomy which preceded seven reoperations, five for thrombosis of the graft or a superficial femoral artery which was patent initially. Although 218 limbs had an occluded or severely stenosed superficial femoral artery, only 26 (12%) required reoperation within the first 2 years. The authors believe that the incidence of reoperation after aortofemoral bypass can be reduced by identifying the limbs at risk, by appropriate selection for percutaneous transluminal angioplasty, avoiding blind outflow endarterectomy and considering concomitant femoropopliteal bypass when gangrene is present.