[Role of extra-anatomical bypasses in the treatment of aorto-iliac occlusion].
In the last six years we have performed 468 operations because of aortoiliac occlusion or septic complications of these arteries. 410 (87.6%) of these operations were anatomical reconstructions, in 58 (12.4%) patients we performed extra anatomical bypasses. The distribution of the operations was the following; 12 obturator, 23 femoro-femoral crossover, 13 axillofemoral and 10 axillobifemoral bypasses. The indication for extra-anatomical reconstruction in 24 (41.4%) patients was septic complication (EABS), and in 34 cases (58.6%) poor general condition or difficulties during surgery. The average age of the patients with non-septic indication (EABNS) was significantly higher than the average age of the patients treated with anatomical reconstruction (AR) (66.3 vs. 60.9 year, p < 0.01). There were more REDO operations in the group EABNS then in the AR group (35.3%/11.7% p < 0.02). Despite of the high operative risk, the rate of early complications (EABNS 13.8%, AR 10%) and postoperative mortality (EABNS 3.7%, AR 4.0%) was not statistically different between the two groups. If the indication was aorto-duodenal fistula (6 patients) or acute limb ischaemia (7 patients), the mortality was significantly higher compared to other extra-anatomical operations (46.2% vs. 4.4%, p < 0.01). The postoperative mortality after EABNS and EABS operations was similar (11.7% vs. 16.6%), but we performed more reoperations after EABS operations (10/24 vs. 2/34, p < 0.05). According to our early postoperative results elective extra-anatomical bypasses are suitable for the treatment of aortoiliac occlusion in high risk patients, with poor life expectancy. Extra-anatomical bypasses are performed because of acute ischemia or septic complications which are life or limb threatening complications, so early results must be validated concerning this fact.
Kaliszky
Péter
P
Semmelweis Egyetem AOK I. sz. Sebészeti Klinika, 1082 Budapest. ka@seb1.sote.hu
Jámbor
Gyula
G
Gáti
József
J
Pajor
Péter
P
Gyurkovics
Endre
E
D000368:Aged; D001011:Aorta / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D004378:Duodenal Diseases / Q000601:surgery; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D007412:Intestinal Fistula / Q000601:surgery; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality