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[Bifurcated prosthesis in infrarenal aortic position in stenosing lesions. Functional results]
G Illuminati1, A Bertagni, F G Caliò
1IV Clinica Chirurgica, Università degli Studi di Roma, La Sapienza, Roma.
Insights
Infrarenal aortic bifurcated grafts for occlusive disease show high success rates. This study found 93% of patients achieved good functional results, supporting aggressive surgical treatment for peripheral artery disease.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Biomaterials Science
Background:
- Peripheral artery disease (PAD) significantly impacts patient quality of life.
- Aorto-iliac-femoral occlusive disease requires effective revascularization strategies.
- Infrarenal aortic bifurcated grafts are a common treatment option for advanced PAD.
Purpose of the Study:
- To evaluate the long-term outcomes of infrarenal aortic bifurcated grafts in patients with occlusive disease.
- To assess graft patency, patient survival, and functional recovery after surgery.
- To determine the efficacy and safety of this surgical approach.
Main Methods:
- A retrospective follow-up study of 58 patients who underwent infrarenal aortic bifurcated grafting.
- Minimum follow-up period of 2 years, with a mean follow-up of 54 months.
- Data collected on patient demographics, disease stage, surgical technique, complications, and functional outcomes.
Main Results:
- Postoperative mortality was 3.5%. Late graft thrombosis occurred in 12% of patients, with 8 reinterventions.
- A good or fair functional result was achieved in 93% of patients at a mean of 54 months.
- 82% of patients returned to normal work activity, and 67% reported improved or unchanged sexual function.
Conclusions:
- Infrarenal aortic bifurcated grafting demonstrates favorable long-term outcomes for occlusive disease.
- The procedure offers significant functional improvement and return to normal activities for most patients.
- An aggressive surgical approach using these grafts is supported by the reported results.
Abstract:
Fifty-eight patients operated upon of infrarenal aortic bifurcated grafts for occlusive disease, in a 6-year period, have been followed-up with a minimum interval of 2 years. The patients were in claudication stage in 63% of the cases and in critical limb threat ischemia in 37% Bypass consisted always in a bifurcated knitted dacron graft either pre-coagulated or sealed. Infrarenal aorta has always been the donor axis, whereas distal anastomosis has been performed on both common femoral in 80% of the cases, on at least one external iliac in 20%. In 5% of the cases a femoro-popliteal bypass has been associated to the main procedure. Postoperative mortality was 3.5%. The occlusion of a prosthetic branch in the postoperative period occurred in one case, requiring a major amputation. Seven patients (12%) presented 11 late thrombosis of one prosthetic branch or both on an interval varying from 4 to 62 months. Eight occlusions required reintervention. Only one, lethal, late prosthetic sepsis was recorded. In a mean interval of 54 months, a good or fair functional result was achieved in 93% of the patients. Out of 22 patients specifically questioned upon, 82% returned to their normal work activity, whereas 18% retired but had a fully normal everyday's life. Sexual function was ameliorated or unchanged in 67% of the cases, while it was impaired in 33%. Eighty-seven percent of the followed-up patients did not require any further hospitalisation for atherosclerotic disease, while 13% of them experienced subsequent hospitalisation or reintervention for progression of the disease either at the same or at different arterial sites. Overall good results support an aggressive attitude towards aorto-iliac-femoral grafting for occlusive disease.