title: Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease.
abstract: OBJECTIVE
  Open surgery has given way to endovascular grafting in patients with aortoiliac occlusive disease. The growing use of endovascular grafts means that fewer patients with aortoiliac occlusive disease have open surgery. The declining open surgery caseload challenges the surgeon's operative skills, particularly because open surgery is increasingly used in those patients who are unsuitable for endovascular repair and hence technically more demanding. We assessed the early outcome after aortic bifurcated bypass procedures during two decades of growing endovascular activity and identified preoperative risk factors.
  
  
  METHODS
  Data on patients with chronic limb ischemia were prospectively collected during a 20-year period (1993 to 2012). The data were obtained from the Danish Vascular Registry, assessed, and merged with data from The Danish Civil Registration System.
  
  
  RESULTS
  We identified 3623 aortobifemoral and 144 aortobiiliac bypass procedures. The annual caseload fell from 323 to 106 during the study period, but the 30-day mortality at 3.6% (95% confidence interval [CI], 3.0-4.1) and the 30-day major complication rate remained constant at 20% (95% CI, 18-21). Gangrene (odds ratio [OR], 3.3; 95% CI, 1.7-6.5; P = .005) was the most significant risk factor for 30-day mortality, followed by renal insufficiency (OR, 2.5; 95% CI, 1.1-5.8; P = .035) and cardiac disease (OR, 2.1; 95% CI, 1.4-3.1; P < .001). Multiorgan failure, mesenteric ischemia, need for dialysis, and cardiac complications were the most lethal complications, with mortality rates of 94%, 44%, 38%, and 34%, respectively.
  
  
  CONCLUSIONS
  Aortic bifurcated bypass is a high-risk procedure. Although open surgery has increasingly given way to endovascular repair, 30-day outcomes have remained stable during the past decade. Thus, it is still acceptable to consider an aortic bifurcated bypass whenever endovascular management is not feasible.
authors.affiliation: Department of Vascular Surgery, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark. Electronic address: kimbredahl79@gmail.com.
authors.forename: Kim
authors.initials: K
authors.lastname: Bredahl
authors.affiliation: Department of Vascular Surgery, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark; The Danish Vascular Registry, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Leif Panduro
authors.initials: LP
authors.lastname: Jensen
authors.affiliation: Department of Vascular Surgery, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark; Centre for Clinical Education, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
authors.forename: Torben V
authors.initials: TV
authors.lastname: Schroeder
authors.affiliation: Department of Vascular Surgery, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Sillesen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Nielsen
authors.affiliation: Department of Vascular Surgery, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark; The Danish Vascular Registry, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jonas P
authors.initials: JP
authors.lastname: Eiberg
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D002908:Chronic Disease; D003251:Constriction, Pathologic; D003718:Denmark; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology / Q000601:surgery*; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency