Emergency Surgery in Late Occlusion of Aortobifemoral Bypass Reconstructions

Abstract

Personal experience of 66 late reoperations following occlusion of aortofe moral bypass procedures of patients operated for occlusive arterial disease of the lower extremities emphasizes that two possibilities exist: either a situation of compensation allowing a deferred evaluation of the problem (55 cases) or an emergency situation (11 cases) due to: 1) acute ischemia of the lower limbs (6 cases); 2) possibility of intestinal infarction (3 cases); 3) ascending thrombosis of the abdominal aorta (2 cases). The aim of the reoperation is to restore a good runoff usually with an endar terectomy of the profunda femoral artery (PFA) and angioplasty of this vessel or, when the profunda femoral artery does not give good reliability, with a fe moropopliteal or femorotibial bypass. Moreover, adequate blood flow must always be guaranteed in at least one of the hypogastric arteries by retrograde flow, reimplantation of the internal iliac artery or, as a last resort, by reimplantation of the inferior mesenteric artery (IMA) . It is necessary to underline that in a patient with occlusion of one graft limb, who had been conservatively treated for unremarkable subjective symp tomatology, the occlusion of the contralateral branch usually requires reopera tion with revascularization of at least one external iliac artery.