Recurrent aortic occlusion

In a review of 134 aortic occlusions in 123 patients, there were 10 patients that suffered recurrent aortic occlusions (RAO). These patients developed RAO after revascularization for primary aortic occlusion and presented with signs and symptoms of acute lower extremity ischemia. The recurrent occlusions occurred in one native aorta and in 10 aortobifemoral grafts. The etiology of the primary aortic occlusion included chronic aortic occlusion in eight patients and acute aortic occlusion and aortic graft occlusion in one patient each. Original primary operations performed included aortoiliac thromboendarterectomy with Dacron patch aortoplasty (1 patient), AF bypass (8 patients), and aortofemoral graft thrombectomy (1 patient). All of the grafts had end-to-end proximal anastomoses, the diameter of which ranged from 12 to 16 mm. Secondary operations performed for RAO included six axillofemoral bypasses, four redo aortobifemoral bypasses, and one graft thrombectomy. All patients were managed with immediate anticoagulation, expeditious arteriography, and revascularization. There were no perioperative deaths, and no limbs were lost. No patient was lost to follow-up (mean 10 years). Extra-anatomic bypass has proved durable. Redo aortobifemoral bypass is useful in selected patients with surgically correctable lesions.