Extra-anatomic bypass for aorto-iliac occlusive disease in the elderly

Abstract

Objective To evaluate the extra-anatomic bypass surgery for aorto-iliac occlusive disease in the elderly. Methods From January 2005 to December 2008,33 elderly patients/39 limbs （age ranged from 70 to 87 years, mean 76.0 ± 3.0 years） with aortoiliac occlusive disease were retrospectively analyzed. According to Fontaine classification, there were 5 phase Ⅱ b cases （7 limbs）, 22 phase Ⅲ cases （26 limbs）, and 6 phase Ⅳ cases （6 limbs）, all cases were with TASC C, D lesions. Results These 33 cases/39 limbs were tr eated with a variety of bypass, including axillobifemoral bypass （6 cases/12 limbs） ,axillofemoral bypass （ 20 cases/20 limbs ）, femorofemoral bypass （ 7 cases/7 limbs ）. Intermittent claudication improved in 5 cases, rest pain disappeared in 22 cases, and ulcers healed in 6 cases after operations. The mean ABI increased from 0.29 ± 0.11 to 0.66 ± 0.13 （ t = 2.69, P 〈 0.05 ）. All limbs were salvaged and there was no perioperative mortality within 30 days after operations. Postoperative complication rate was 9.1%. Patients were followed up for a median of 12 ±5 months （range, 6 to 28 months）, primary patency rate was 89.7% （35/39）, secondary patency rate was 94.9% （37/39）, limb salvage rate was 92.3% （36/39）. After dischargement the mortality was 6.1% （2/33） with one dying of myocardial infarction and another one of malignant tumor （gastric cancer）. Conclusions Extra-anatomic bypass for aorto-iliac occlusive disease in the elderly is feasible, safe and effective, and the cardiopulmonary dysfunctions are the major risk factors for perioperative complications. Key words: Arteriosclerosis obliterans; Vascular surgical procedures; Extra-anatomy bypass; Aged