AORTOILIAC AND AORTOFEMORAL RECONSTRUCTION OF OBSTRUCTIVE DISEASE

This retrospective study evaluates our strategy to limit prosthetic re constructions for aortoiliac obstructive disease to the diseased segme nts in 518 patients. There were 363 (70%) reconstructions without femo ral anastomotic sites (FEM-0), 107 (21%) reconstructions with one femo ral anastomotic site (FEM-1), and 48 (9%) aortobifemoral reconstructio ns (FEM-2). The ischemic symptoms and the extent of obstructions were significantly more severe in the FEM-1 and FEM-2 groups than in the FE M-0 group. Early operative results were comparable in all three groups . The difference in outcome became apparent when the long-term results were considered. Long-term follow-up continued for up to 20 years aft er the operation. Primary and secondary patency rates were significant ly higher in the FEM-0 group (9% and 4% recurrent obstructions per 5 y ears, respectively) than in the FEM-1 and FEM-2 groups (both 14% and 1 0%, respectively), which was explained by patient selection. Late addi tional surgery was performed after aortoiliac procedures in most cases for recurrent aortoiliac obstruction and after aortofemoral procedure s in most cases for false aneurysms. The risk of late additional opera tions during long-term follow-up were significantly lower in the FEM-0 group than in the FEM-1 and FEM-2 groups. These results support our s trategy to tailor prosthetic reconstructive surgery to the individual status of the aortoiliac arteries.