Serial hemodynamic assessment of aortobifemoral bypass

Clinical, arteriographic, and vascular diagnostic laboratory (VDL) data on 157 patients undergoing aortobifemoral bypass (ABF/BP) more than 5 years previously were compared in terms of the perspective provided by noninvasive testing, particularly when performed in the face of superficial femoral artery (SFA) occlusion. To the traditional outcome criteria (operative mortality rate, 3.2%; amputation rate, 1.4%; early patency rate, 98%; and late patency rate, 86%), VDL data added an initial hemodynamic failure rate of 14% and a late deterioration rate of 8%. Those patients with occluded SFAs fared worse in regard to initial patency (94% vs. 100%), initial hemodynamic failure (29% vs. 2%), late deterioration (8.8% vs. 5.4%), and late failure rates (16% vs. 10%), whereas those patients with open SFAs suffered more distal disease progression (11.5% vs. 1.3%). "Prediction" of postoperative ankle/brachial index (ABI) from preoperative thigh/brachial index (TBI) and ABI was 92% accurate for limbs with open SFAs but only 84% for limbs with occluded SFAs; prediction was made with a formula based on proportional transmission and with TBI measured with a regularly sized cuff (best combination). Neither additive transmission formula nor measurement of TBI with a large cuff allowed accurate prediction when the SFA was occluded. No advantage, in terms of initial hemodynamic result or late outcome, could be demonstrated for limited profundaplasty in the absence of significant profunda femoral stenosis and end-to-end vs. end-to-side proximal anastomosis.