[The extra-anatomic bypass in the therapy of aortoiliacal occlusive disease].
The extra-anatomic bypass procedure is a well accepted alternative to direct aortoiliac reconstruction in high-risk patients or in cases of local inoperability. Between 1980 and 1987 74 patients (54 men, 20 women; mean age = 71 years, 43 to 90) underwent a total of 78 extra-anatomic reconstructions: 23 axillounifemoral, 15 axillobifemoral, 34 femoro-femoral cross-over, 4 axillo-popliteal and 2 femoro-popliteal cross-over bypasses. The operations were performed for severe claudication in 16, rest pain in 27 and gangrene in 26 patients; acute ischaemia was the indication in 6 and acute aortic aneurysms in 2 cases; in 1 patient there was an infected bifurcation graft. At a median follow-up time of 11 months the secondary patency rates for axillofemoral and femoro-femoral cross-over bypasses are predicted to be 75%, 71% and 62% after 1, 3 and 5 years, respectively (Kaplan-Meier estimate); on exclusion of vein and composite grafts, the patency rate increases to 79%, 75% and 65%, respectively. Femoro-femoral cross-over grafts seem to produce better results than axillounifemoral grafts (86% versus 77% at 3 years; logrank p greater than 0.05). The patency of the superficial femoral artery providing good run-off conditions, an appropriate technique for performing the anastomoses and adequate choice of graft material appear to improve the results.
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II. Chirurgische Universitätsklinik, Wien.
Staudacher
M
M
Donath
P
P
Schreiner
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors
Der extraanatomische Bypass in der Therapie der aortoiliakalen Verschlusskrankheit.