Revision of the proximal aortic anastomosis after aortic bifurcation surgery.
The implantation of an aortic bifurcation graft (ABG) for treatment of occlusive (OD) and aneurysmal (AD) aortoiliac disease is a standard technique with good long-term results and a relatively low incidence of complications. In a retrospective review of our patients from 1964 to 1993 only 36/1520 patients were identified who required reoperation at the proximal aortic anastomosis after ABG. Indications were graft occlusion (15/36) and graft stenoses (2/36), refractory to graft thrombectomy, proximal aortic anastomotic aneurysms (11/36) or graft infection (8/36). Graft occlusion or stenosis most frequently led to aortic reoperation in the OD-group (53.5%), recurrent aneurysmal disease (37.5%) and graft infection (37.5%) were the dominant indications in the AD-group. Mean time interval to reoperation was shorter in cases of graft infection (35 +/- 33 months) as compared with graft stenosis (66 +/- 58 months), graft occlusion (86 +/- 49 months) or aortic anastomotic aneurysms (152 +/- 90 months). Of the reoperations, 92% were done electively, 8% as emergency procedures. The perioperative course was uneventful in 67% of patients. Overall mortality rate after elective revisional surgery was 3% but reached 66% in emergencies. Postoperative morbidity and mortality was related to preoperative morbidity and the urgency of surgery, not with the mode of aortic intervention nor indication.
Kraus
T W
TW
Department of Surgery, University of Heidelberg, Germany.
Paetz
B
B
Hupp
T
T
Allenberg
J R
JR
D000714:Anastomosis, Surgical; D001012:Aorta, Abdominal / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D004630:Emergencies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000601:surgery; D006801:Humans; D017543:Iliac Aneurysm / Q000601:surgery*; D007083:Iliac Artery / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D016459:Prosthesis-Related Infections / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors