Fate of the Iliac Arteries after Repair of Abdominal Aortic Aneurysm with an Aortobifemoral Bypass Graft

Abstract

The objective of this study is to determine the fate of the iliac arteries after repair of abdominal aortic aneurysm with an aortobifemoral bypass graft. It is a prospective natural history study at a university-affiliated urban teaching hospital. Thirty-two patients with retrograde flow to the iliac circulation after repair of an abdominal aortic aneurysm by aortobifemoral bypass grafting were studied. All patients were followed prospectively with repeat CAT scans, clinical assessment, and selective angiography to determine the fate of the iliac circulation. We were particularly interested in subsequent vessel thrombosis or aneurysmal dilation. Patient survival was analyzed with a Kaplan-Meier life-table and survival curve. Graft patency was analyzed using life-table analysis. Primary outcomes included iliac artery size, graft patency, and patient survival. The iliac arteries remained constant in size or thrombosed in all study patients. Iliac expansion did not occur in any of the study patients. Secondary graft patency was 100%. The cumulative survival rate at 47 months was 0.55 (0.37-0.74, 95% confidence interval). Retrograde perfusion of diseased iliac arteries after aortobifemoral bypass for repair of abdominal aortic aneurysm is safe. Iliac artery atherosclerotic, ectatic or small aneurysmal disease (< or = 3 cm) does not appear to be a contraindication to retrograde iliac artery perfusion.