[180 aorto-bifemoral bypasses for chronic occlusive arteritis]

In the authors' experience, 180 aorto-bifemoral by-pass grafts represent 42.4% of all reconstructive operations for aorto-iliac atheromatous disease performed between 1st January 1972 and 1st July 1983. 37% of the patients presented a threatened amputation and 38.8% had a walking distance of less than 100 metres. The immediate post-operative mortality (1st month) was 2.2% (4 patients). The 5 year survival, expressed according to the actuarial method, was 89% and the patency was 91%. The long-term functional deterioration was due to a progressive alteration of the distal vascular bed and to complications: false aneurysms (2.2%), prosthetic infections (1%), aorto-intestinal fistulae (2.2%), thrombosed prostheses (7.3%). 7 complementary femoro-popliteal by-pass grafts (4%) and 13 major amputations (7.4%) were required. The authors stress the value of performing end-to-end aortic anastomoses rather than side-to-end anastomoses. The anastomoses should be well isolated from the gastrointestinal tract. The patients should be rigorously followed post-operatively and any complication detected should be treated actively.