AORTOFEMORAL BYPASS AND DETERMINANTS OF EARLY SUCCESS AND LATE FAVORABLE OUTCOME - EXPERIENCE WITH 1000 CONSECUTIVE CASES

Experience with 1000 cases of aorto-(bi)femoral bypass is presented ev aluating factors influencing the overall patency rate and late surviva l, over a period of 25 years. There were 820 cases with bilateral and 180 with a unilateral bypass. Mortality was 3.3% and death rate 39.4%. Re-do procedures have been excluded. Operative indications were for s tage I. disease (moderate claudication) (17.6%), stage II (advanced cl audication) (53.2%), stage III (rest pain and/or pregrangrenous change s) (22.7%) and stage IV (gangrenous tissue loss (6.5%). Myocardial inf arction was the predominant cause of late death in 192 cases (48.7%), followed by cancer in 48 (13%), cerebrovascular disease in 43 (11%), c hronic lung disease with cor pulmonale in 15 (3.8%) and miscellaneous causes in 52 (13.2%) of patients. The cause of death was unknown in 31 (7.8%) cases. Co-existent peripheral arteriopathy (PAD) noted in 377 (37.7%) patients, was found to be a major determinant of late graft pa tency. Carotid artery disease and renovascular hypertension were corre cted surgically, prior to aorto-femoral bypass in the 5.6% and concomi tantly in 4.2%. Coronary artery disease in 273 (27.3%) patients and hy pertension in 269 (26.9%), had a great influence on late survival as d id age and smoking habits. Endarterectomy together with profundaplasty was carried out in 162 (16.2%) instances. It was our policy to extend the graft limb over the profunda femoris and in cases with co-existen t superficial femoral artery disease 208 (20.8%). In 630 (63%) instanc es, the distal anastomosis was performed at the level of common femora l artery. Immediate graft patency was obtained in 99.3% of the cases. Late patency rate for stages I and II at 5, 10 and 15 years was 82%, 7 6% and 72% respectively. Following secondary operation for graft occlu sion, the 15 year patency was increased to 71%. Co-existent superficia l femoral disease can be alleviated by appropriate concomitant profund aplasty. Amputation rates were 0.8% for stage II, 1.5% for stage III a nd 2.4% for stage IV disease. Twenty year life table analysis showed a reduced survival (54%), in comparison with normal population (77%).