title: Patterns and outcomes of aortofemoral bypass grafting in the era of endovascular interventions.
abstract: OBJECTIVE
  The aim of the study is to study contemporary presentation patterns and clinical results in patients undergoing aortofemoral bypass (AFB) surgery.
  
  
  METHODS
  This was a retrospective comparative study.
  
  
  METHODS
  During a 14-year period, 269 consecutive patients (mean age 65 years) underwent AFB. Indications included occlusive disease with severe intermittent claudication (IC) (n = 86), critical limb ischaemia (CLI, n = 97) and aneurysmo-occlusive disease (n = 86).
  
  
  RESULTS
  From 2000-07 on, AFB was performed more frequently for occlusive disease with CLI than for other indications (48% vs. 31% before 2000, P = 0.009) and also in women (51% vs. 32% before 2000, P = 0.003), compared to the period before 2000. Thirty-day mortality was reduced during 2000-2007 to 2.4%, compared with 4.3% during 1993-1999, although this difference was not statistically significant (P = 0.73). Morbidity did not change substantially over the study period. Predictors of 30-day mortality included indication (CLI = 4.1% vs. claudication = 1.2% (P = 0.37)) and chronic kidney disease (CKD, serum creatinine > 1.5 mg dl⁻¹) (11.1% vs. 2.9% in normal renal function, P = 0.07), the latter being the single predictor on multivariate analysis (hazard risk 4.2, P = 0.047). Overall 5 and 10-year assisted primary and secondary patency was 95% and 88%, and 99% and 95%, respectively. Survival at 5 and 10 years was 69% and 48%, respectively. Patient age (hazard risk 1.05, P < 0.001), CKD (hazard risk 1.79, P = 0.018) and diabetes (hazard risk 1.56, P = 0.022) were independent predictors of worse long-term survival. Long-term outcome did not change over the course of the study.
  
  
  CONCLUSIONS
  In the contemporary era, AFB is more likely to be performed for CLI and in women than in the past. Despite these changes, perioperative mortality and morbidity remain low and long-term outcome excellent.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI 48202, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Kakkos
authors.forename: M J
authors.initials: MJ
authors.lastname: Haurani
authors.forename: A D
authors.initials: AD
authors.lastname: Shepard
authors.forename: T J
authors.initials: TJ
authors.lastname: Nypaver
authors.forename: D J
authors.initials: DJ
authors.lastname: Reddy
authors.forename: M R
authors.initials: MR
authors.lastname: Weaver
authors.forename: J C
authors.initials: JC
authors.lastname: Lin
authors.forename: G K
authors.initials: GK
authors.lastname: Haddad
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007083:Iliac Artery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D058017:Vascular Grafting; D014654:Vascular Patency