[Treatment of ischemia in late thrombosis after aorto-iliaco-femoral reconstructions].
Late thrombosis of inserted prosthetic grafts for arterial reconstructive surgery is one of the most frequent late complication. Its incidence is influenced by many factors: hemodynamic conditions, quality of run-in and run-off, technical aspects of the primary repair. Progressive arteriosclerosis in femoral vessels was the cause of graft limb thrombosis in most instances. When graft occlusion does occur, there is, in a majority of patients, an immediate return of ischemia which often is severe and redo-operation is indicated to restore circulation. A new angiogram is mandatory, especially for the recognition of the inflow to the central anastomosis and for the evaluation of the distal run-off. Several surgical techniques are in use for redo-operation (graft thrombectomy with or without graft prolongation, partial or total replacement of the prosthesis, reconstruction by an extra-anatomical by-pass). Very important is the role of the deep femoral artery: in patients with a multi-level occlusive disease a patent deep femoral artery most often provides an effective inflow repair with a combined use of profundaplasty and lumbar sympathectomy. In this report of 188 late thrombosis, in a twenty year experience, at the Department of General and Cardiovascular Surgery, University of Milan, we made a redo-operation in 83% of the cases, according our preference in surgical procedures, to the partial substitution of the prosthesis with large profundaplasty. An associated lumbar sympathectomy was performed in 25% of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Giuffrida
G F
GF
Miani
S
S
Bergamaschi
E
E
Mingazzini
P
P
Giordanengo
F
F
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001012:Aorta, Abdominal / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*
Il trattamento dell'ischemia nelle trombosi tardive delle ricostruzioni aorto-iliaco-femorali.