title: Open repair for aortic occlusive disease: indication, techniques, results, tips and tricks.
abstract: OBJECTIVE
  The aim of this article was to review indications, techniques, and outcomes of a series of open repair for aortic occlusive disease.
  
  
  METHODS
  Between 1991 and 2013, 1071 patients (917 men, 154 women; mean age 62.6 years) underwent open repair for aortoiliac occlusive disease. According to TASC II classification, 123 patients (11.5%) had type B lesions, 343 (32%) type C, and 605 (56.5%) type D. Among type D lesions, 138 patients had Leriche's Syndrome with complete aortic occlusion. Nine hundred and eight aortobifemoral bypasses, 114 axillo-bifemoral bypasses, 42 aortic endarterectomies with patch aortoplasty, and 7 thoracobifemoral bypasses were performed. Associated endarterectomy of abdominal aorta was required in 191 patients (18.5%), of the femoral arteries in 297 (28.7%).
  
  
  RESULTS
  Perioperatively mortality was 0.6%; perioperative morbidity included cardiac (3.4% of patients), respiratory (2.6%), as well as acute renal insufficiency (2.6%). There were 26 (2.5%) cases of intraoperative distal embolization, 9 (0.8%) of acute graft thrombosis and 9 (0.8%) of bleeding requiring surgical revision within the first 24 hours after surgery. Sixty-one groin complications were reported in 57 patients (5.3%). During a mean follow-up time of 74 months (range 1-264), calculated actuarial occlusion-free survival at 12, 24, and 36 months was 94.8%, 91.8% and 87.2%, respectively. The limb-salvage rate in patients with critical limb ischemia was 87.3%. There were 11 (1%) graft infections.
  
  
  CONCLUSIONS
  Open repair is a ductile strategy and may be tailored according to the patient clinical condition and disease anatomy. Long-term patency is excellent with low perioperative mortality and reasonable morbidity rates.
authors.affiliation: Vascular Surgery Department of Cardio‑Thoraco‑Vascular Surgery Università Vita‑Salute Scientific Institute H. San Raffaele, Milan, Italy - y.tshomba@hsr.it.
authors.forename: Y
authors.initials: Y
authors.lastname: Tshomba
authors.forename: G
authors.initials: G
authors.lastname: Melissano
authors.forename: L
authors.initials: L
authors.lastname: Apruzzi
authors.forename: D
authors.initials: D
authors.lastname: Baccellieri
authors.forename: G
authors.initials: G
authors.lastname: Negri
authors.forename: R
authors.initials: R
authors.lastname: Chiesa
mesh_terms: D000671:Amputation, Surgical; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D004691:Endarterectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency