Infrainguinal arterial reconstructions with vein grafts in patients with prior aortic procedures: the influence of aneurysm and occlusive disease.
OBJECTIVE
This study assessed whether infrainguinal reconstructions with autogenous vein (IR) performed in patients with prior abdominal aortic aneurysm (AAA) repairs have altered graft patency, compared with those in patients who have undergone prior aortobifemoral bypass grafting procedures (ABF) for aortoiliac occlusive disease.


METHODS
From 1979 to 1998, 54 patients with prior aortic reconstructions underwent 64 autogenous single-segment saphenous IRs solely for infrainguinal occlusive disease. Included in this cohort were 30 IRs with an earlier AAA repair and 34 IRs with an earlier ABF repair. During the same period, 1274 patients underwent 1642 autogenous vein lower-extremity bypass grafting procedures (LEB). Lower-extremity native arterial (AAA, n = 6; ABF, n = 11) and vein graft diameters (AAA, n = 6; ABF, n = 6) were determined by means of angiography and duplex ultrasonography, respectively. The three reconstruction groups (AAA, ABF, LEB) were compared.


RESULTS
The patients in the three groups were similar in sex, indication for operation, proximal and distal anastomotic site, and number of distal runoff vessels. The cumulative 5-year primary graft patency rate in the AAA group (92% +/- 5%) was significantly higher (P <. 001) than that in the LEB group (63% +/- 2%) and the ABF group (44% +/- 11%). Furthermore, cumulative 5-year primary patency was decreased in the ABF group compared with the LEB group (P =.05). A significant increase in both native arterial (P =.001) and vein graft diameter (P <.05) was demonstrated by using linear regression and a Student t test, respectively, in the AAA group compared with the ABF group.


CONCLUSIONS
These data demonstrate that, compared with those in patients without a previous aortic procedure, IRs in patients with prior AAA repairs have significantly improved graft patency, and IRs in patients with prior ABF reconstructions for aortoiliac occlusive disease have significantly decreased graft patency. Larger arterial diameter and altered vein graft adaptation may contribute to the superior long-term outcomes of IRs in patients with prior AAA repairs.
Upchurch
G R
GR
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Conte
M S
MS
Gerhard-Herman
M D
MD
Lanoue
M Z
MZ
Donaldson
M C
MC
Mannick
J A
JA
Whittemore
A D
AD
Belkin
M
M
D000222:Adaptation, Physiological; D000368:Aged; D000714:Anastomosis, Surgical; D000792:Angiography; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001161:Arteriosclerosis / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007264:Inguinal Canal / Q000098:blood supply; D007866:Leg / Q000098:blood supply; D015993:Life Tables; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000637:transplantation*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency