[Extra-anatomic bypass as a method of choice for surgical correction of iliofemoral lesions in elderly patients].
From fall 1994 to December, 2000, total 73 reconstructions of iliofemoral lesions (predominately of atherosclerotic origin) were fulfilled in 70 elderly patients. Long-term outcomes (to 5 years of follow-up) of iliofemoral surgical interventions for 2B-4 grade lower limb ischemia were assessed. The first group (mean age 74.5) included patients with extra-anatomic reconstructions (31), control group (mean age 70.1) comprised "direct" iliofemoral bypass (42 procedures). Intervention extend was determined by diagnostic data (Doppler ultrasonography, duplex scanning, angiography) and severity of concomitant pathology. Elderly cohort of patients is especially vulnerable to multilevel atherosclerotic lesions, thus practically in all cases distal anastomosis was formed with deep femoral artery eliminating its stenosis. Cumulative rate of fatal outcome toward the end of 2000 in the first group was somewhat higher then in control. Causes of deaths in the first group were characterized by greater variety, while in control one half of deaths was related to acute coronary insufficiency. In survivors of the first group recurrent lower limb ischemia occurred in 3 cases, in 2 of them resulting in amputation. In control lower limb ischemia relapsed in 6 patients with subsequent limb amputation in 4 of them for thrombosis of iliofemoral bypass. Toward the end of 2000 patent grafts numbered 54.2% in the first group and 71.9% in control, rate of limb salvage - 87.5% and 82.5%, respectively. High risk of lethal outcome in elderly patients with multifocal atherosclerotic lesions and severe comorbidities during standard iliofemoral reconstructions permit to consider extra-anatomic bypass as one of possible surgical solutions, that enables to achieve good clinical and functional results, to save a limb without expansion of procedure invasiveness.
Frolkov
Iu A
IuA
Department of cardiovascular surgery, Military Veterans Hospital No. 2, Moscow, Russia.
Kondrat'eva
O V
OV
Troshin
A Z
AZ
D000368:Aged; D000714:Anastomosis, Surgical; D001157:Arterial Occlusive Diseases / Q000503:physiopathology* / Q000601:surgery*; D005263:Femoral Artery / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology* / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*