OPTIMAL METHODS OF AORTOILIAC RECONSTRUCTION

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  • 1 January 1978
    • journal article
    • research article
    • Vol. 84  (6) , 739-748
Abstract
Alternate methods of aortic reconstruction for aortoiliac occlusive disease were reviewed in 582 patients (1105 limbs) during the 15 yr period from 1963-1977. To illustrate certain trends, separate analyses were done for periods 1963-1969 (interval I) and 1970-1977 (interval II). During the earlier period, endarterectomy was performed in 72% of patients, with unilateral operations carried out in 15% of patients. Operative mortality was 5.1% and early failure occurred in 4% of the patients. In interval II, graft procedures were done in 89% of patients, with mortality of only 2% and early failure in less than 1% of the patients. Unilateral procedures were utilized infrequently (4%). Aortoiliac endarterectomy is apparently still the procedure of choice for a small group (approximately 10%) with localized disease. For more extensive disease, aortofemoral grafts appear to be the procedure of choice. Patency of such grafts in the most recent interval was 91% at 5 yr. Superior long-term function of aortofemoral grafts appears to be associated with use of a knitted Dacron prosthesis, end-to-end proximal anastomosis and distal anastomosis which ensures patency of the profunda femoris outflow. The incidence of infection (0.3%) and false aneurysm formation (1.4%) was extremely low. In view of the low mortality rate and superior long-term success of direct reconstructions, extraterritorial grafts are rarely indicated.