[Late obstructions of aorto-bifemoral prostheses]

The factors underlying late thrombosis of aortobifemoral by-pass are analysed on the basis of personal experience and reported data. They are considered to be due to progressive degradation of the prosthesic tissue and, particularly, to the lack of an adequate back flow route, apart from any faults in the actual construction of the femoral anastomosis. Treatment of the thrombotic complication involves considerable technical and operating problems which have two main solutions: substitution of the thrombosed branch, or its disobstruction. Intimately linked with restoral of by-pass patency is the reconstruction of an adequate back flow route either by means of profundaplasty or by extending the branch as far as popliteal level. Of 83 patients discharged with patent prosthesis, thrombosis occurred in 7 and 10 reoperations were necessary. Reconstruction of branch patency was done in the majority of cases by thrombectomy. Profundaplasty was associated in 4 cases while in other 4 popliteal extension was necessary. Analysis of results shows that the operation of choice on the affluxion route seems to be replacement of the thrombosed branch.