LONG-TERM SURVIVAL AFTER RECONSTRUCTIVE OPERATION IN PATIENTS WITH ARTERIOSCLEROSIS OBLITERANS

Postoperative long-term survival for arteriosclerosis obliterans (ASO) of lower extremities was examined in 218 patients who underwent recon structive surgery from 1973 to 1992. The causes of late deaths and the ir relation to the arteriosclerosis of various organs were also examin ed. Patients were divided into three groups according to the type of o peration: aortoiliac/femoral (AIF), axillo/femorofemoral (AxF), and fe moropopliteal bypass (FP) and were then divided into two subgroups acc ording to the times of operation: ''former decade'' (subgroup F, 1973- 1982, AIF 43, AxF 31, FP 10) and ''latter decade'' (subgroup L, 1983-1 992, AIF 58, AxF 40, FP 36). The mean ages at operation for AIF-F/L we re sixty/sixty-three years, and these were significantly younger than sixty-nine/seventy for AxF-F/L and sixty-five/sixty-seven for FP-F/L. There were 74 late-death patients, and of them, 57 (77%) died of arter iosclerosis-related diseases of various organs such as ischemic heart disease. Among these 57 patients, 39 (68%) experienced organ failure a s a preoperative complication, whereas in the remaining 18, such failu re was not clinically evident prior to operation. The survival rates a t five/ten years after operation were 84%/61% in AIF-F, 88%/76% in AIF -L, 49%/20% in AxF-F, 75%/52% in AxF-L, and 73%/73% in FP-L. The survi val rate at ten years for subgroup L was 66% and was higher as compare d with 42% for subgroup F owing in large part to the significant impro vement in AxF. In conclusion, for patients with ASO, postoperative lif e expectancy improved recently, but arteriosclerosis of various organs was still the main cause of late deaths. Lifelong critical care for s ystemic organs was necessary even in patients in whom such lesions wer e not yet clinically evident at the time of operation.