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Extraanatomic vascular reconstruction in patients with aorto-iliac arteriosclerosis
Insights
Femorofemoral crossover bypasses offer better survival and patency rates than axillofemoral bypasses for aorto-iliac arteriosclerosis, despite similar initial mortality. Crossover grafts are recommended for improved long-term outcomes.
Area of Science:
- Vascular Surgery
- Cardiovascular Disease
- Surgical Outcomes
Background:
- Aorto-iliac arteriosclerosis affects elderly patients with multiple comorbidities, increasing surgical risks.
- Extraanatomic bypasses are utilized for complex cases where direct reconstruction is not feasible.
Purpose of the Study:
- To compare the outcomes of axillofemoral bypass versus femorofemoral crossover bypass for treating aorto-iliac arteriosclerosis.
- To evaluate survival, patency rates, and complication frequencies between the two surgical techniques.
Main Methods:
- Retrospective analysis of 117 extraanatomic reconstructions over 11 years.
- Categorization into 36 axillofemoral and 81 femorofemoral crossover bypasses.
- Life table analysis for survival and patency rates.
Main Results:
- Postoperative mortality was 10% for both procedures.
- Axillofemoral bypass had significantly more early and late complications, including reoperations for occlusion.
- Femorofemoral crossover bypass demonstrated superior survival and graft patency rates.
Conclusions:
- Femorofemoral crossover bypass is associated with better long-term outcomes compared to axillofemoral bypass in patients with aorto-iliac arteriosclerosis.
- While mortality is similar, the higher complication and reoperation rates for axillofemoral bypass warrant consideration.
- Graft choice should prioritize long-term patency and patient survival.
Abstract:
During an 11-year period 117 extraanatomic reconstructions were made for aorto-iliac arteriosclerosis; 36 axillofemoral and 81 femorofemoral crossover bypasses. The patients were old and had several factors making them poor risks for surgery. Axillofemoral grafts were more often used in patients with malignant disease. Postoperative mortality was 10% without difference between the two types of reconstruction. Both early and late complications were significantly more frequent in patients with axillofemoral bypass. Reoperations for occlusion and symptoms from the donor side also were significantly more common among axillofemoral patients. Life table analysis showed a higher survival and patency rate among patients with crossover grafts.