AN ALGORITHM FOR THE SURGICAL-MANAGEMENT OF CHRONIC ABDOMINAL AORTIC OCCLUSION AND OCCLUDED AORTOFEMORAL GRAFTS

An algorithm for the surgical management of chronic abdominal aortic o cclusion is presented based upon experience of treating 60 consecutive patients. Of 33 patients with juxtarenal aortic occlusion, 17 underwe nt aortofemoral bypass (AFB), 10 descending thoracic aortofemoral (DTA F), 5 axillofemoral (AxF) bypass, and 1 ascending thoracic aortofemora l bypass. Of 11 patients with mid or distal aortic occlusion, 8 underw ent AFB, 2 DTAF and 1 AxF. Of 16 patients with aortic graft occlusion, 1 underwent AFB, 10 DTAF and 5 AxF. Acceptable risk patients were sel ected for AFB (26). DTAF (22) was frequently preferred for patients wi th occluded aortic grafts or other hazardous intraabdominal pathology. AxF (11) was used for patients with severe cardiopulmonary risk, limi ted life expectancy from malignancy, or when emergency procedures were required for salvage of severely ischemic limbs in debilitated patien ts with chronic aortic occlusion. In the AFB, DTAF and AxF groups the perioperative mortality was 8%, 5% and 36% respectively, the late mort ality was 15%, 36% and 45%, and the 5-year primary cumulative graft pa tency was 92%, 89% and 15%.