High Aortic Occlusion: Surgery and Prognosis / 日本心臓血管外科学会雑誌

From 1976 to 1993, 13 patients with high aortic occlusion were treated surgically. Bypass grafting from infrarenal abdominal aorta to the iliac or femoral arteries was performed in 9 patients, endarterectomy with patch angioplasty in 2, thrombectomy followed by straight graft replacement in 1 and bilateral axillo-femoral artery bypass grafting in 1. In 9 patients, femoro-popliteal run-off was determined by arteriography before or during operation. Occlusion of the femoral artery was detected in two patients, and femoro-popliteal bypass grafting was simultaneously performed with aortic revascularization. Two patients died in the early postoperative period (1: fulminant hepatitis, 1: cerebral infarction), and 4 patients died in the late postoperative period (2: ischemic heart disease, 1: cerebral bleeding, 1: malignant tumor). In one patient the iliac artery occluded 13 years after endarterectomy. All other patients showed patent grafts and satisfactory conditions. In cases of high aortic occlusion, late postoperative results were satisfactory after anatomical revascularization. Ischemic heart disease and cerebral vascular accident were important concerning late complications. Postoperative careful follow-up is necessary.

Arterial Reconstruction for Femoropopliteal Occlusive Disease Due to Arteriosclerosis. A Retrospective Comperative Study between Endarterectomy and Femoropopliteal Bypass / 日本心臓血管外科学会雑誌

During the past thirteen years, 75 patients (97 limbs) with femoropopliteal occulusive disease due to arteriosclerosis were treated by surgical reconstructions. The 75 patients consisted of 70 men and 5 women with an age range of 32-83 years (mean±SD: 65.9±9.6 years). Regarding the indications for operation, intermittent claudication was found in 46 patients (61%), rest pain in 24 patients (32%) and gangrene in 5 patients (7%). As the atherosclerotic risk factors, cigarette smoking and hypertension were present in high rates, and ischemic heart disease was complicated in 31.4%. Endarterectomy with vein angioplasty was performed for 31 limbs and bypass operation usually using EPTFE grafts was for 66 limbs. Cumulative patency rate at five years was 72.6% in endarterectomy group, and 48.1% in bypass group. At ten years, 72.6% and 36.1%. Comparisons of the patency rate between two technics, endarterectomy was significantly better than bypass oparation in late postoperative period. Endarterectomy is recommended as the treatment of choice for femoropopliteal occulusive disease, because of the long-term patency.