title: An algorithm for the surgical management of chronic abdominal aortic occlusion and occluded aortofemoral grafts.
abstract: An algorithm for the surgical management of chronic abdominal aortic occlusion is presented based upon experience of treating 60 consecutive patients. Of 33 patients with juxtarenal aortic occlusion, 17 underwent aortofemoral bypass (AFB), 10 descending thoracic aortofemoral (DTAF), 5 axillofemoral (AxF) bypass, and 1 ascending thoracic aortofemoral bypass. Of 11 patients with mid or distal aortic occlusion, 8 underwent AFB, 2 DTAF and 1 AxF. Of 16 patients with aortic graft occlusion, 1 underwent AFB, 10 DTAF and 5 AxF. Acceptable risk patients were selected for AFB (26). DTAF (22) was frequently preferred for patients with occluded aortic grafts or other hazardous intraabdominal pathology. AxF (11) was used for patients with severe cardiopulmonary risk, limited life expectancy from malignancy, or when emergency procedures were required for salvage of severely ischemic limbs in debilitated patients with chronic aortic occlusion. In the AFB, DTAF and AxF groups the perioperative mortality was 8%, 5% and 36% respectively, the late mortality was 15%, 36% and 45%, and the 5-year primary cumulative graft patency was 92%, 89% and 15%.
authors.affiliation: Department of Cardiovascular Surgery, Geisinger Medical Center, Danville, PA 17822-1343.
authors.forename: D E
authors.initials: DE
authors.lastname: Bowes
authors.forename: J R
authors.initials: JR
authors.lastname: Youkey
authors.forename: D P
authors.initials: DP
authors.lastname: Franklin
authors.forename: C H
authors.initials: CH
authors.lastname: Benoit
authors.forename: W F
authors.initials: WF
authors.lastname: Pharr
mesh_terms: D000368:Aged; D000465:Algorithms; D001012:Aorta, Abdominal / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D002908:Chronic Disease; D004691:Endarterectomy; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014654:Vascular Patency