Treatment of Aortoiliac Occlusions According to Multiple Competiting Therapeutic Options

ABSTRACT

The aortoiliac segment is one of the common site of chronic arterial occlusive disease which causes ischemic symptoms in the legs and feet. From March 1992 to December 1997, we performed 45 aortobifemoral bypasses, 14 femorofemoral bypasses, 3 iliofemoral bypasses, 1 ilioiliac bypass and 2 axillobifemoral bypasses. In 45 aortofemoral bypasses, 8 end-to-end proximal anastomosis and 37 side-to-end anastomosis were done. Adjuvant PTA with/without stent insertion before bypass operation were performed in 10 cases. Occlusive patterns of the disease were type I in 10.9%, type II in 23.5% and type III in 65.6% respectively. Associated diseases were hypertension, diabetes, cerebrovascular accidents, and myocardial infarction in order of frequency. In cardiac risk analysis according to the Eagle's criteria, high risk group was 4.7%, intermediate risk group was 53.1% and low risk group was 42.2% of total. Mean duration of follow-up was 12.1 months. Cumulative patency rate by life table analysis was 83.1%. Leg or foot amputations were done in 10 cases (15.6%) after operation and graft occlusion in 11 cases (17.2%). Two cases of amputation were done after 12 simultaneous infrainguinal bypasses, but 4 cases of after 10 staged infrainguinal bypasses. Operative mortality were 3 cases (4.7%). Conclusively, aortobifemoral bypass is still standard procedure in extensive aortoiliac occlusive disease in patients with low operative risk. And simultaneous infrainguinal bypass is preferred in patients with poor distal run-off. Alternatively, iliofemoral or extraanatomical bypasses are also considered case by case.