Inflow and outflow disease in aortofemoral grafting.
During a 16-year period 88 aorto-ilio-femoral grafts were performed, with an overall mortality rate of 3.4%. Two major amputations were required (2.3%). Immediate patency was accomplished in 93.2% of cases, while 1-year, 3-year, 5-year and 7-year patency rate was respectively of 90.7%, 87.3%, 81.6%, 71.9%. Preoperative outflow disease was the most important factor responsible for early thrombosis and for late occlusion. No relation, on the contrary, could be identified between preoperative inflow disease and immediate and late patency. In the present series proximal anastomosis of aortofemoral bifurcation grafts was end-to-side in almost every instance, ensuring aortic endarterectomy through an aortotomy proximal to the inferior mesenteric artery, with a digital and instrumental closure of the aorta just below the renal arteries. Simple lateral clamping was restricted to the few cases without inflow impairment. Such a technique proved to be safe and effective in avoiding distal embolization of debris and in ensuring satisfactory results.
D001012:Aorta, Abdominal / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D008297:Male; D008722:Methods; D014654:Vascular Patency