[Early results after aortoiliac reconstruction in our department in the past six years].
The authors analyze early postoperative results of 320 patients operated on because of aortoiliac occlusion. The mortality of the interventions was 4.1%, the proportion of reocclusions was 7.2% and the rate of amputations was 3.1%. The operations were as follows: 88 aorto-bifemoral bypasses, 157 iliofemoral bypasses, 75 iliofemoral thrombendarteriectomies. There were no statistical variations in the rate of mortality, complications and amputations between different types of operations. Comparing the results of aortobifemoral bypasses with opening of the peritoneal cavity (6 patients died of 74, i.e. 8.1%) with those performed retroperitoneally (14 patients no death), despite the marked difference there was no significant difference probably due to the small number of patients (p = 0.34). In 26% it was necessary to extend the reconstructions distally to peripheral arteries or deep onto the profundal femoral artery. The peripheral extension did not effect early mortality, or amputation rate. Seven patients needed reoperation because of general surgical reasons, with 2 mortalities (28.6%), both had bowel necrosis; mortality rate was significantly higher compared to other patients (p < 0.05). Vascular complications developed in 30 cases. The mortality and the amputation rate of 27 reoperated patients was 3.7%, which did not differ significantly from the results of other patients group. Fifteen operations were carried out because of acute ischaemia, 4 patients were lost (26.7%), significantly more than after elective operations (305/9, 2.95%, p < 0.01). In our department retroperitoneal approach in aortobifemoral bypasses decreased mortality. If the quality of the outflow is uncertain or insufficient, one has to consider immediate distal extension. We must to do everything to prevent--or to diagnose and treat--bowel necrosis. The mortality rate of aortoiliac occlusions causing acute ischaemia is high, therefore we must consider the adoption of extraanatomical bypasses.
Kaliszky
Péter
P
Semmelweis Egyetem Altalános Orvostudományi Kar I. sz. Sebészeti Klinika, 1082 Budapest. ka@seb1.sote.hu
Jámbor
Gyula
G
Nagy
Zoltán
Z
Borka
Katalin
K
Regáli
László
L
D000208:Acute Disease; D000368:Aged; D000671:Amputation, Surgical; D001012:Aorta, Abdominal / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000601:surgery*; D002908:Chronic Disease; D004691:Endarterectomy; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D006814:Hungary; D007083:Iliac Artery / Q000601:surgery*; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D017131:Thrombectomy; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality