OPTIMAL SITE FOR PROXIMAL AND DISTAL ANASTOMOSES IN AAAS REPAIR

The replacement of straight graft for vascular aortic reconstruction, in the elective treatment of aortic and aorto-iliac aneurysms, is advi sable and requires only two anastomoses and a low surgical risk. In ou r report we have tried to identify the simplest vascular reconstructio n for juxtarenal involvement (15% in our experience), reducing the sur gical time and the operative (or postoperative) injuries. The decision to employ the tube or the bifurcated reconstruction depends on the su rgeon's assessment of the degree of common iliac dilatation, the prese nce of an iliac aneurysm or the concomitance of occlusive disease of t he iliac-femoral district. Some authors extend the bifurcated repair t o prevent the possible future occlusive events or iliac dilatation. We have much information about the natural history of aortic aneurysms b ut we have also to define the indications for a valuable surgical reco nstruction. We have considered a consecutive serie of 20 patients who underwent elective aortic and aortoiliac aneurysm repair in S. Rita pr ivate hospital; in 13 patients (65%) the aneurysms were treated with t ube grafts, the other patients received bifurcate grafts: 3 (15%) aort o-bisiliac, 2 (10%) aortobifemoral and 2 (10%) right aorto-iliac and l eft aortofemoral bypass procedure. We employed Crawford's inclusion in the juxtarenal involvements, generally without the reimplantation of renal arteries, ex tending the tube repair in the aorto-iliac dilatati on, obtaining a simplification of the surgical procedures. The use of straight graft allows a sensible decrease of surgical operating time, a reduction of hematic loss and a very low incidence of postoperative injuries; this solution became possible also in some selected forms of aneurysmatic involvement of renal arteries. The criterion to exclude the tube graft reconstruction is the presence of aneurysm or occlusive disease in the iliac femoral district.