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Inflow and outflow disease in aortofemoral grafting
Insights
Aorto-ilio-femoral bypass surgery demonstrated a low mortality rate and high graft patency. Preoperative outflow disease significantly impacted graft success, while inflow disease did not affect outcomes.
Area of Science:
- Vascular Surgery
- Surgical Outcomes
- Graft Patency
Background:
- Aorto-ilio-femoral bypass is a critical intervention for peripheral artery disease.
- Long-term graft patency and patient survival are key metrics for surgical success.
Purpose of the Study:
- To evaluate the outcomes of aorto-ilio-femoral bypass surgery over a 16-year period.
- To identify factors influencing early thrombosis and late occlusion of aorto-ilio-femoral grafts.
Main Methods:
- Retrospective analysis of 88 aorto-ilio-femoral grafts performed over 16 years.
- Assessment of mortality, major amputations, and graft patency rates (immediate, 1, 3, 5, and 7 years).
- Correlation of preoperative inflow and outflow disease with graft outcomes.
Main Results:
- Overall mortality was 3.4%, with 2.3% requiring major amputations.
- Immediate graft patency was 93.2%, with 7-year patency at 71.9%.
- Preoperative outflow disease was linked to early thrombosis and late occlusion; inflow disease showed no correlation.
Conclusions:
- Aorto-ilio-femoral bypass surgery offers safe and effective results with acceptable long-term patency.
- Managing preoperative outflow disease is crucial for optimizing surgical outcomes.
- The described surgical technique effectively prevents distal embolization and ensures satisfactory results.
Abstract:
During a 16-year period 88 aorto-ilio-femoral grafts were performed, with an overall mortality rate of 3.4%. Two major amputations were required (2.3%). Immediate patency was accomplished in 93.2% of cases, while 1-year, 3-year, 5-year and 7-year patency rate was respectively of 90.7%, 87.3%, 81.6%, 71.9%. Preoperative outflow disease was the most important factor responsible for early thrombosis and for late occlusion. No relation, on the contrary, could be identified between preoperative inflow disease and immediate and late patency. In the present series proximal anastomosis of aortofemoral bifurcation grafts was end-to-side in almost every instance, ensuring aortic endarterectomy through an aortotomy proximal to the inferior mesenteric artery, with a digital and instrumental closure of the aorta just below the renal arteries. Simple lateral clamping was restricted to the few cases without inflow impairment. Such a technique proved to be safe and effective in avoiding distal embolization of debris and in ensuring satisfactory results.