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Late occlusion of aortofemoral bypass graft: surgical treatment
L Pedrini1, E Pisano, M Donato Di Paola
1Department of Vascular Surgery, University of Bologna, Italy.
Insights
Redo surgery for aortofemoral bypass graft thrombosis is challenging. Best outcomes for graft thrombosis involve distal anastomosis reconstruction, reserving redo surgery for severe limb ischemia or disabling claudication.
Area of Science:
- Vascular Surgery
- Graft Patency
- Peripheral Vascular Disease
Background:
- Graft thrombosis after aortofemoral bypass is a significant complication.
- Rethrombosis is common, complicating surgical outcomes.
Purpose of the Study:
- To analyze outcomes of reoperations for aortofemoral bypass graft thrombosis.
- Identify factors influencing reoperation success and patient survival.
Main Methods:
- Retrospective review of 803 patients (1261 limbs) undergoing aortofemoral bypass.
- Analysis of 71 patients requiring 125 reoperations over a mean follow-up of 6.3 years.
Main Results:
- Intimal hyperplasia was the primary cause of graft thrombosis.
- Reconstruction with graft interposition or patch angioplasty yielded the best patency rates.
- Isolated thrombectomy had a high rethrombosis rate (53.3%).
Conclusions:
- Redo surgery for graft thrombosis should be reserved for severe limb ischemia or disabling claudication.
- Achieved 5-year secondary patency of 81.7% and 10-year survival of 89.2%.
- Amputation and mortality rates were 14% and 5.6%, respectively.
Abstract:
Surgical treatment for graft thrombosis is often difficult and its outcome is complicated by a high incidence of rethrombosis. The records of 803 patients (1261 limbs) treated with aortofemoral bypass graft for peripheral vascular disease were reviewed. Among these, 71 patients (63 men and eight women with a mean age of 60.2 years) needed an overall number of 125 reoperations. The mean follow-up was 6.3 years. Smoking was significantly higher in these patients compared with those who were not reoperated on. Intimal hyperplasia was the most common lesion responsible for graft thrombosis. Before 'redo' surgery 20 patients with recent thrombosis received thrombolytic treatment; one was subsequently treated with percutaneous transluminal angioplasty and the others underwent reoperation. The best patency rates were achieved with reconstruction of the distal anastomosis with a graft interposition or with a patch angioplasty. Isolated thrombectomy was complicated by early rethrombosis in 53.3% of cases. The overall amputation rate was 14%, the operative mortality rate 5.6%, and the incidence of complications 16.8%. At follow-up a cumulative secondary patency rate of 81.7% at 5 years (74.5% at 10 years), a limb salvage rate of 80.5%, and a survival rate of 89.2% at 10 years were recorded. It is concluded that the only indications for redo surgery following graft thrombosis are severe limb ischaemia or disabling claudication.