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Long-term results of operative therapy for aortoiliac disease
Insights
Aortic bifurcation grafts effectively treat aortoiliac disease, relieving critical limb ischemia. However, combined superficial femoral artery occlusions reduce claudication symptom relief and impact long-term graft patency due to disease progression.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Interventional Radiology
Background:
- Aortoiliac disease is a significant cause of peripheral artery disease.
- Combined superficial femoral artery occlusions complicate treatment and outcomes.
- Understanding graft performance in complex cases is crucial.
Purpose of the Study:
- To evaluate the outcomes of aortic bifurcation grafts in patients with aortoiliac disease.
- To compare results in patients with and without coexisting superficial femoral artery occlusions.
- To identify factors influencing late graft failure.
Main Methods:
- Retrospective analysis of 140 patients operated on for aortoiliac disease over 11.5 years.
- 81 patients had combined segment disease (aortoiliac + superficial femoral artery occlusions).
- Aortic bifurcation grafts were the primary surgical intervention.
Main Results:
- Grafts provided uniform relief of rest pain and threatened gangrene.
- Claudication relief was significantly poorer in patients with combined segment disease.
- Late graft failures were attributed to disease progression, not graft material defects.
- Cumulative patency rates were 98.0% at 1 year and 94.6% at 3 years.
Conclusions:
- Aortic bifurcation grafting is effective for limb salvage in complex aortoiliac disease.
- Coexisting superficial femoral artery disease adversely affects claudication outcomes.
- Long-term graft success depends on managing progressive atherosclerotic disease.
Abstract:
Over a period of 11 1/2 years, 140 patients were operated on for aortoiliac disease; 81 had coexisting superficial femoral artery occlusions (combined segment disease). Patients with combined segment disease were older, had twice the incidence of diabetes, and significantly more rest pain and gangrene on presentation. Aortic bifurcation grafts were placed in 114 patients. Relief of rest pain and threatened gangrene was uniformly good. However, relief of claudication was significantly poorer in patients with combined segment disease. There were 11 "late" thrombotic graft occlusions. Six grafts with distal anastamoses to the external iliacs failed because of limb outflow problems, while five grafts to the common femoral position exhibited more diffuse problems. Late graft failures were due to progression of disease and not problems intrinsic to the grafts. Cumulative patency rates were 98.0% at one year and 94.6% at three years.