title: Influence of distal arterial occlusive disease on prognosis following aortobifemoral bypass.
abstract: Arteriographic criteria were used to classify 376 consecutive patients who underwent aortobifemoral bypass for aortoiliac occlusive arterial disease between 1967 and 1977. Group A (126 patients, 34%) had isolated aortoiliofemoral disease, group B (156 patients, 41%) had associated femoropopliteal disease, and group C (94 patients, 25%) had associated femoropopliteal and tibioperoneal disease. Ischemic rest pain or tissue necrosis was the indication for operation in 13% of patients in group A, 30% of those in group B (P < 0.01), and 45% of those in group C (P < 0.001). The overall operative mortality rate was 5.6%, and differences in operative mortality among the three groups had no statistical significance. Fatal postoperative myocardial infarctions occurred in 4.5% of the entire series and accounted for 17 (81%) of 21 postoperative deaths. Late follow-up information for 3 to 13 postoperative years (mean, 6.3 years) was available for 337 (95%) of 355 operative survivors. Subsequent femoropopliteal or femorotibial bypass was necessary for 8% of patients in group A, 13% of those in group B, and 19% of those in group C (P < 0.05), but the presence of distal occlusive disease was not associated with meaningful differences in cumulative aortofemoral limb patency or major amputation. The late mortality rate was 28% for group A, 33% for group B, and 41% for group C. Myocardial infarctions were responsible for 46% of all late deaths and occurred in 11% of patients in group A, 15% of those in group B, and 20% of those in group C. The mortality rate (P < 0.01) and the incidence of fatal myocardial infarction (P < 0.02) within five postoperative years were statistically significant in group C.
mesh_terms: D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011859:Radiography