[Reoperations for early recurrent occlusions following femoropopliteal and femorocrural bypasses].
We analyse the early results of 333 patients who had been operated on because of femoropopliteal occlusions between 1996 and 2000. Most interventions (90.4%) were below knee reconstructions. The rate of crural bypasses was high (40.5%). We examined whether the length and type of the graft influenced the outcome of the primary operation. If below knee bypass was necessary in every operation autologous grafts were preferred either partially or entirely (saphenous vein or arm vein). The number of reocclusions and amputations was significantly higher if the distal anastomosis involved the crural arteries (p < 0.02), or the graft was not autologous (p < 0.01). There was no statistical difference between early results of saphena and arm vein bypasses (p = 0.2). Thirty-six reoperations were performed for early graft failures. Either the patient's general condition or local findings did not allow reoperations in 17 patients with occluded graft, they were treated conservatively. Nine patients died after surgery (2.7%). In the postoperative period 21 major amputations were necessary (6.3%), in six cases the graft was patient. After reoperations 7 patients needed amputations (19.4%), in the 17 patients not reoperated on the second time, 8 amputations were necessary (47%), the difference is significant (p < 0.05). We are convinced about the importance of urgent reoperation in case of early graft occlusion. If the run-off to the distal arteries was doubtful intraoperative angiography was performed. When distal extension of the operation was necessary we tried to use autologous grafts. The amputation rate was significantly lower after reoperations if the cause of graft occlusion was found and corrected compared to simple thrombectomies (p < 0.05).
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Semmelweis Egyetem AOK I. sz. Sebészeti Klinika, 1082 Budapest, Ullói út 78. ka@seb1.sote.hu
Gyurkovics
Endre
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Nehéz
László
L
Nagy
Zoltán
Z
D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014656:Vascular Surgical Procedures
Femoropoplitealis és femorocruralis bypass mútéteket követóen korai elzáródás miatt végzett reoperációink.