AORTIC RECONSTRUCTIVE SURGERY FOR LIMB ISCHEMIA - IMMEDIATE AND LONG-TERM FOLLOW-UP TO PROVIDE A STANDARD FOR ENDOVASCULAR PROCEDURES

Purpose: Aortobifemoral and aortobiliac bypass has been a preferred tr eatment of severe aortoiliac occlusive disease. Recently, endovascular procedures and unilateral bypass grafting have been introduced. We re port the results of aortic reconstructive surgery over a 19-year perio d (1975-1994). Methods: A total of 285 patients underwent surgery. Fol low-up data from clinical notes, general practitioner questionnaire or phone interview was available in 93.3% (266/285). Results: Of the tot al 68% were male (180/226) and the median age was 63 years (range 22-8 5 years). Indications for surgery were tissue loss/gangrene (n = 32), rest pain (n = 84), severe claudication (n = 40), moderate claudicatio n (n = 110). Total of 177 bifurcated grafts, 51 iliofemoral, eight lef t/right aortofemoral, and 30 other procedures were performed. The medi an duration of follow-up was 49.8 months. Cumulative secondary graft p atency for 2, 5 and 10 years was 97.7%, 95.9%, and 94.4%. The amputati on rate was 4.5% (12/266). Early mortality occurred in eight of 266 pa tients (3%) and late mortality in 60 patients. The most common cause o f late death was ischaemic heart disease (24/60 followed by cancer (14 /60). Data was further analysed by type of graft, risk factors, compli cations and previous and subsequent surgery. In our experience, aortic reconstructive surgery is a successful option for the management of s evere aortoiliac occlusive disease. The outcome of other methods of ma intaining arterial patency should be measured against this standard. ( C) 1998 The International Society for Cardiovascular Surgery. Publishe d by Elsevier Science Ltd. All rights reserved.