[Treatment of late occlusions and stenoses after an aortofemoral bypass operation]

Thirty-three patients with one or several late occlusions in 43 limbs of aortofemoral dacron grafts underwent 56 reconstructions because of impending limb loss. Thrombectomy alone with patch closure was less successful. Excision of the femoral anastomosis, resection of the distal part of the occluded prosthetic limb and replacement by a new velours graft tube together with profundaplasty and further downstream reconstruction revealed the best results. The early reocclusion rate was 10%, the late reocclusion rate was 10%. There was no operative mortality and no amputation. Two late deaths occurred, in one case due to grade III infection with sepsis. Another late graft infection was successfully managed by an extraanatomic bypass and excision of the infected limb. The reasons for late occlusions of aortofemoral grafts were found to be incomplete reconstruction of the outflow tract, technical failure at the time of primary reconstruction and progressive atherosclerosis. Hypertonus was common in all cases with progression of the disease. Technical details of the operative management for late occlusion are presented.