LIGATION AND EXTRAANATOMIC ARTERIAL RECONSTRUCTION FOR THE TREATMENT OF ANEURYSMS OF THE ABDOMINAL-AORTA

Purpose: Since Blaisdell et al. first described axillobifemoral bypass and aortic exclusion to treat patients at high risk with abdominal ao rtic aneurysms in 1965, this approach has been controversial. To help define the appropriate application of this procedure, the recent exper ience of the authors was reviewed. Methods: Twenty-six patients underw ent operation between March 1980 and August 1992. Mean age was 71 +/- 7 years. Average aneurysm diameter was 7.0 +/- 1.5 cm. Sixty-nine perc ent of the aneurysms were symptomatic; 21% were suprarenal. Al patient s had serious comorbid factors. All underwent axillobifemoral bypass w ith iliac artery ligation; the infrarenal aorta was also ligated in 62 %. Results: There were two postoperative deaths (7.7%). One- and two-y ear survival rates were 59% and 38%, respectively. Three patients died of aneurysm rupture (11.5%); the aorta had not been ligated in two of these patients. The remaining late deaths were due to comorbid condit ions. Extraanatomic bypass grafts thrombosed in five patients; no limb s were lost. Conclusions: Axillobifemoral bypass without aortic Ligati on does not effectively reduce the risk of aneurysm rupture. However, axillobifemoral bypass with aortic ligation is an acceptable treatment for patients with severe medical problems and symptomatic, anatomical ly complicated, or large abdominal aortic aneurysms. Because the risk of aneurysm rupture is not completely eliminated, this procedure shoul d be reserved for patients with high-risk aneurysms who would not tole rate direct aortic replacement.