[Transplant occlusion following aortofemoral bifurcation bypass: causes, therapeutic measures and results].
35 patients with graft thrombosis following aortobifemoral bypass grafting were analysed retrospectively (1971-1983). In 24 of these patients aortobifemoral bypass graft was performed in our own hospital and the thrombosis rate was 9.1%. 40 bypass branches and 54 graft occlusions were involved. Late occlusions were more common (75.9%), occurring after an average time interval of a little more than 5 years. Inadequate peripheral run-off with progression of the atherosclerosis was the cause in 37.5%. In 40.0% the site of occlusion was in the proximal segment of the graft, where kinking related to anastomotic technical problems played a major role. The transfemoral ring or balloon thrombectomy was successful in 45.5%. In 24.2%, however, this had to be combined with a bypass procedure (femoropopliteal or femorocrural). A change of the graft was indicated in 48.5%, but this was considered too risky in 30.3% (extraanatomic bypass: change of graft = 1.7:1). In the case of poor distal run-off a peripheral corrective procedure was a must for graft patency. In every second patient this could be achieved by profunda revascularisation. Occlusions at the central bifurcation segment are better prevented by proper anastomotic techniques. A graft with a short main trunk anastomosed to the high infrarenal aortic segment ensures a safer anastomosis and a proper position of the graft branches with little possibility of kinking. Since the routine use of this method a graft thrombosis caused by central technical problems has not been seen.
D000368:Aged; D000671:Amputation, Surgical; D001012:Aorta, Abdominal / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001161:Arteriosclerosis / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007511:Ischemia / Q000209:etiology; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D013536:Suture Techniques; D013927:Thrombosis / Q000209:etiology* / Q000601:surgery
Transplantatverschluss nach aorto-femoralem Bifurkationsbypass: Ursachen, therapeutische Massnahmen und Ergebnisse.