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Prosthetic bifurcation grafting in occlusive and aneurysmal aortoiliac disease--a follow-up study
S Soisalon-Soininen1, J A Salo, R Luosto
1Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
Insights
Patients undergoing surgery for abdominal aortic aneurysms (AAA) or aortoiliac occlusive disease (AIOD) had similar survival rates. AAA patients experienced better graft patency and fewer amputations, highlighting the need for cardiac screening before surgery.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Clinical Outcomes Research
Background:
- Prosthetic bifurcation grafting is a common surgical procedure for abdominal aortic aneurysms (AAA) and aortoiliac occlusive disease (AIOD).
- Patient demographics and risk factors differ between AAA and AIOD, potentially influencing surgical outcomes.
Purpose of the Study:
- To compare the clinical outcomes of prosthetic bifurcation grafting in patients with non-ruptured AAA versus AIOD.
- To identify factors influencing graft patency, amputation rates, mortality, and survival in these patient groups.
Main Methods:
- A comparative clinical study involving 135 patients with AAA and 180 patients with AIOD, operated between January 1982 and December 1986.
- Analysis of patient demographics, comorbidities (hypertension), lifestyle factors (smoking), distal run-off, graft patency, amputation rates, operative mortality, and late survival.
Main Results:
- AAA patients were older, predominantly male, had higher rates of hypertension, and better distal run-off compared to AIOD patients.
- Graft patency and late survival rates were better in the AAA group, with lower amputation rates.
- No significant differences were observed in operative mortality or overall late survival rates between the two groups.
- Cardiac mortality was a significant factor affecting survival in both patient cohorts.
Conclusions:
- While graft patency and amputation rates favor AAA patients, overall survival and operative mortality are comparable between AAA and AIOD groups after bifurcation grafting.
- Cardiac comorbidities significantly impact long-term survival in both patient populations.
- Systematic, non-invasive screening for myocardial status is recommended for patients undergoing elective surgery for AAA or AIOD to optimize perioperative management and improve outcomes.
Abstract:
A comparative clinical study was made of patients undergone prosthetic bifurcation grafting for non-ruptured abdominal aortic aneurysm n = 135 or aortoiliac occlusive disease n = 180 between January 1982 and December 1986. Patients in aneurysmal group were older, predominantly men, had hypertension more often and had better distal run-off at the time of operation. Smoking was over-presented among aortoiliac occlusive disease patients. Patients operated for abdominal aortic aneurysms had better early and late graft patency rates and lower late amputation rates. There were no significant differences in operative mortality rates and late survival rates between occlusive disease and aneurysmal patients. Cardiac mortality mainly reduced early and late survival rates in both patient groups. We should begin to use systematically a reliable and non-invasive method for screening the myocardial status in patients who are going to be operated for abdominal aortic aneurysm or aortoiliac occlusive disease.