The role of graft material in aortic reconstructive surgery

Graft replacement of an aneurysmal abdominal aorta and bypass grafting for aorto-iliac occlusive disease has proven effective since synthetic materials were introduced three decades ago. During the period 1978-1981, 584 patients underwent aortic reconstruction for aneurysmal or aorto-iliac occlusive disease. Two hundred fifty-four patients (43%) were operated for aneurysms while 330 (57%) patients had symptomatic aorto-iliac occlusive diseases. There were 508 (87%) men and 76 (13%) women. Associated disease was common, with 245 patients (42%) having arteriosclerotic heart disease, 291 (50%) hypertensive, 128 (22%) having manifestations of extracranial occlusive disease, and 50 (8.6%) having diabetes mellitus. Sixty-four (10%) patients in this series had coronary revascularization prior to their aortic graft. One hundred five (17.9%) carotid endarterectomies had been performed previously or immediately prior to aortic grafting. Distal reconstructive operations had been performed in 106 patients (18%). Renal or mesenteric revascularizations were performed concomitantly in 87 and eight patients, respectively. One hundred two femoral reconstructions or distal bypasses were also performed to assure adequate outflow. Thirteen (2.27%) deaths occurred during the first 30 days. Cardiac problems accounted for eight of these deaths. Graft occlusion occurred in the immediate postoperative period in four (0.4%) limbs. During the follow-up, an additional seven limbs (1.04%) have occluded. There have been no other complications associated with the grafts during the follow-up period. Results in this series affirm the authors' strong commitment to direct aortic reconstruction.