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Aortoiliac occlusive disease: factors influencing survival and function following reconstructive operation over a
Insights
Reconstructive surgery for aortoiliac atherosclerotic occlusive disease offers good early functional results in 95% of patients. Long-term survival and function are significant, with low amputation rates, especially for claudication.
Area of Science:
- Vascular Surgery
- Cardiovascular Disease
- Atherosclerosis Research
Background:
- Aortoiliac atherosclerotic occlusive disease (AOD) affects numerous patients, often with comorbidities.
- Surgical reconstruction is a primary treatment for symptomatic AOD, including claudication and critical limb ischemia.
Purpose of the Study:
- To evaluate the long-term outcomes of reconstructive operations for aortoiliac atherosclerotic occlusive disease.
- To assess survival rates, functional results, and amputation incidence in a large patient cohort over 25 years.
Main Methods:
- Retrospective analysis of 949 patients undergoing reconstructive surgery for AOD over 25 years.
- Data collection included patient demographics, comorbidities, surgical procedures, early and late functional outcomes, survival, and amputation rates.
Main Results:
- 95% of patients achieved good early functional results (restored pulses, leg salvage, symptom relief).
- Long-term survival rates were 50% at 10 years, 30% at 15 years, and 15% at 20 years.
- Functional success was maintained in survivors (79% at 10 years, 70% at 15 years, 56% at 20 years), with low amputation rates (3% for claudication, 14% for rest ischemia).
Conclusions:
- Reconstructive surgery for AOD provides durable functional outcomes and significant long-term survival.
- Early results are superior in patients with claudication and without distal disease.
- Comorbidities, particularly heart disease, significantly impact operative mortality and long-term survival.
Abstract:
During a period of slightly over 25 years, 949 new patients with aortoiliac atherosclerotic occlusive disease--409 (43%) with associated distal disease--were submitted to various reconstructive operations for claudication in 719 and rest ischemic problems in 230 patients. The ages ranged from 21 to 91 years with a medial age of 59. Men outnumbered women 2.5 to 1. Associated diseases were present in 695 (75%); heart disease and diabetes were most common. The mortality rate from operation--50% of which was from heart disease--8% in first 5 years and 3% during the last 15 years. Good function, i.e., restoration of femoral pulses, leg salvage, and relief of symptoms, was achieved in 95% of cases early after treatment. Early results were best in patients with claudication and those without associated distal disease. The long-term survival rates were significant--50%, 30%, and 15% at 10, 15, and 20 years, respectively--and successful function was maintained in survivors in 79%, 70%, and 56% at the same intervals. Amputation was performed in only 23 (3%) patients with claudication and 33 (14%) with rest ischemia during the period of study. Survival, functional results, and incidence of amputation varied with the numerous factors described in detail herein.