Management of graft occlusion following aortobifemoral bypass.
BACKGROUND: There is doubt as to whether operative mortality and subsequent graft patency and limb salvage rates support repeated efforts at revascularisation in patients with occluded aortobifemoral grafts. STUDY DESIGN: Prospective study of hospital patients with aortobifemoral graft occlusion presenting to the Durban metropolitan hospitals. The study was designed to assess outcome of revascularisation in these patients. METHOD: This is an analysis of 65 patients who developed graft occlusion out of a total of 492 aortobifemoral bypasses monitored over a 9-year period. Patients were investigated with angiography before being subjected to re-operation. They were followed up in the vascular clinic. RESULTS: The incidence of graft occlusion in this cohort was 15%. There were 11 early occlusions (2.6 days after the procedure) and 54 late occlusions (28 months after the procedure). Eight early graft occlusions were managed by means of thrombectomy, 1 with additional profundoplasty, and 3 were managed conservatively. Late complications were graft occlusion (1), graft sepsis (1) and aorto-enteric fistula (1). Late graft occlusions were managed by crossover (18), profundoplasty (7), axillo-femoral bypass (5), graft limb reconstruction (5) and redo procedures (2); 20 patients were managed conservatively. There was 1 postoperative death among the patients who experienced early occlusion, and none among those with late occlusion. Long term complications included secondary graft occlusions (3), graft sepsis (1) and amputations (5). The limb salvage rate was 63%. CONCLUSION: This study has shown that acceptable results can be achieved with surgery for graft occlusion following aortobifemoral bypass and that different treatment options are available.
Madiba
T. E.
TE
Abdool-Carrim
A. T.
AT
Mars
M.
M
Nair
R.
R
Robbs
J. V.
JV