Advantages of straight graft for abdominal aortic aneurysm repair

The advantages of aneurysm repair with straight tube graft were studied. Between January 1984 and March 1994, 277 patients with abdominal aortic aneurysm underwent operation using straight or bifurcated prosthetic grafts. Of those 277 patients, 37 patients (14%) received straight grafts and the remaining 240 patients received bifurcated ones. These two patient groups were compared in terms of influences of intraoperative aortic clamping, operative time, postoperative recovering condition, incidence of perioperative complications, and long-term results. Hemodynamic influences of aortic clamping were determined by the changes in systemic blood pressure. The duration of aortic clamping was significantly longer in the bifurcated graft group than in the straight graft group (p < 0.01). In addition, the elevation of blood pressure was significantly higher after aortic clamping in the bifurcated graft group than in the straight graft group (p < 0.05) although the blood pressure changes after release of the clamp did not differ significantly. The bifurcated grafts required significantly longer operating time than the straight grafts. There was a tendency for the patients of bifurcated grafts to suffer from complications associated with long duration of the laparotomy, such as pneumonia and bowel obstruction. During an average follow-up period of 5 years, only one patient had to undergo subsequent operation for an aneurysm of the remaining iliac artery. This patient had had a dilatation of the hypogastric artery 1.5 times as large as is normal in the first operation. The long-term results of the remaining 36 patients with straight graft was satisfactory and the remaining iliac arteries were found to be intact. It is concluded that the surgical repair with straight tube graft is a durable procedure for patients with abdominal aortic aneurysms as long as the dilatation of the iliac artery is limited to 1.5 times the normal dilatation.