AAA 12. Juxtarenal Aortoiliac Occlusive Disease—Contemporary Results of Surgical Management and Outcome in a Tertiary Care Center in North India

Abstract

Peripheral artery disease involving the abdominal aorta and iliac arteries due to atherosclerosis is one of the most common therapeutic challenges faced by vascular surgeons. Although there is a paradigm shift in the management of aortoiliac occlusive disease, most patients with extensive aortoiliac disease with juxtarenal aortic occlusion are being referred to vascular surgeons for aortobifemoral bypass as endovascular treatment is complex and long-term data are not available about its durability. During the last 3 years, 15 patients have been managed surgically at our institute with promising results. All patients were planned for conventional aortobifemoral bypass surgery. The surgical technique included control of bilateral renal arteries and suprarenal aortic clamp placement, infrarenal aortotomy and thrombectomy, thorough aortic flushing, and shifting of the clamp to the infrarenal aorta, followed by standard bypass grafting. Aortic clamp time and renal ischemia time were recorded. Fifteen patients (mean age, 54 years) had tissue loss (minor, eight; major, four); claudication pain was the most common symptom. Smoking (86%), diabetes (36%), hypertension (18%), and coronary artery disease (8%) were the most important risk factors. There were no patients with postoperative renal dysfunction or any need for renal replacement therapy. At mean follow-up of 14 months, all the patients were doing fine with good distal blood flow in limbs, confirming graft patency (Figs 1 and 2). Aortobifemoral bypass remains the “gold standard” in management of juxtarenal aortoiliac occlusive disease because of durable bypass with good long-term results. Risk of renal ischemia is low if the procedure is planned well. We used coated polyester graft in all patients, which has shown good midterm graft patency. This study helps in identifying such complex diseased patients and how they can be managed surgically to improve their long-term survival.Fig 2Postoperative computed tomography angiogram scans showing patent grafts with good distal outflow (anteroposterior and lateral views).View Large Image Figure ViewerDownload Hi-res image Download (PPT)