LERICHE-SYNDROME - SURGICAL-PROCEDURES AND EARLY AND LATE RESULTS

During the past thirteen years, 29 patients underwent surgical interve ntion for Leriche syndrome. Fifteen patients (aged forty-two to sevent y-two years, average 60.7 years) underwent anatomical bypass, and 9 of them whose thrombus was confined to the infrarenal aorta received a r outine graft insertion. In the other 6 whose thrombus extended to the level of the renal arteries, an open thrombectomy of the juxtarenal ao rta was first performed through a transection of the infrarenal aorta under renal ischemia (4-14 minutes, average 7). Twelve elderly or high -risk patients (aged sixty-eight to eighty-four years, average 75.3 ye ars) underwent an axillobifemoral bypass, and another 2 (fifty-eight a nd sixty years old, respectively) who had been operated on at an earli er time received an ascending aortobifemoral bypass. In cases of anato mical bypass, no graft has occluded and all patients but 1, who died o f cerebral infarction, have an active life now. In cases of extraanato mical bypass, 5 of the 28 grafts occluded and only 6 patients have sur vived. The other 8 patients died of malignancy, atherosclerotic compli cations, or unknown causes. The 10-year survival rate was 92.9% and 29 .5% in the anatomical bypass and extraanatomical bypass group, respect ively. In Leriche syndrome, anatomical bypass is preferred to extraana tomical bypass if conditions permit. In the juxtarenal type, an open t hrombectomy under renal ischemia is mandatory for anatomical bypass, a nd a transection of the Infrarenal aorta facilitates this procedure. B ecause the patients with Leriche syndrome are elderly and harbor arter iosclerotic lesions, a careful follow-up is mandatory.