Aortic reconstruction vs extra-anatomic bypass and angioplasty. Thoughts on evolving a protocol for selection.
One hundred forty-eight patients were evaluated for inflow revascularization and stratified by age, vascular anatomy, medical history, and cardiac functional class into aortic reconstruction (AR), extra-anatomic bypass (EAB), or iliac angioplasty based on a protocol that restricted AR to good-risk patients and liberalized indications for EAB. Fifty-five patients underwent AR with a 1.8% mortality, 1.8% myocardial infarction and 12% morbidity, and cumulative life-table patency of 94% at two years; 69 patients underwent EAB with no mortality and negligible morbidity; cumulative life-table patency was 93% at two years for crossover femoral and 83% at two years for axillofemoral grafts. Operative selection based on a protocol restricting AR to better-risk patients and liberalizing use of EAB may decrease overall patient mortality and morbidity without jeopardizing limb preservation.
D000368:Aged; D000800:Angioplasty, Balloon; D001011:Aorta / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000628:therapy*; D001366:Axillary Artery / Q000601:surgery; D006328:Cardiac Catheterization; D005069:Evaluation Studies as Topic; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D008722:Methods; D009203:Myocardial Infarction / Q000150:complications; D012306:Risk; D013318:Stroke Volume