[Reconstructive surgery in high-risk arteriopathic patients]

The authors refer on 24 patients over 65 years of age suffering from obliterating arteriopathy of the lower limbs undergoing reconstructive surgery no matter the high surgical risk. These patients represent 12.3% of all vascular patients treated in five years of activity. The following risk factors are considered: 1) Heart disease; 2) Altered lipid metabolism; 3) Diabetes; 4) Arterial hypertension; 5) Hyperuricaemia; 6) Obesity; 7) Renal or hepatic insufficiency. Immediate results were excellent in 23 cases; one patient suffering from aortic barrage died of acute haemorrhagic pancreatitis. Follow-up results also remained good; only one patient had to be re-operated two years later (disobliteration of branch of prosthesis) with a happy outcome. Two other patients died because of non vascular causes. The authors do not consider age amongst risk factors and prefer the extraperitoneal approach in disobliterating operations and refer using the transperitoneal route without problems in aortobifemoral bypasses. The authors state that risk factors did not alter neither the short nor the long-term follow-up results possibly because of medical correction of associated pathological states.