Long-term results of open aorto-femoral reconstructions

Abstract

The objective was to analyze the long-term results of open aorto-femoral reconstructions in order to optimize the approach to surgical treatment.Methods and materials. The study included 548 patients with reconstructions of the aorto-femoral segment performed between 1999 and 2007. Of these, 293 patients underwent loop endarterectomy of the iliac arteries, 255 – after aorto-femoral bypass with a synthetic prosthesis. All interventions were performed against the critical lower limb ischemia. The superficial femoral arteries remained occluded in all cases. Outflow was carried out only in the deep femoral arteries and collateral vessels. Patients were under clinical supervision for 5 to 20 years. In the long-term period, most patients underwent interventions on the coronary, brachiocephalic arteries, as well as surgery for cancer.Results. Timely correction of concomitant pathology made it possible to increase the survival rate of patients by the 10-year follow-up period to 72 %, and after 20 years this figure reached 63 %. The primary patency of the reconstructed segment after loop endarterectomy was significantly higher than after aorto-femoral bypass surgery. Secondary patency in the groups did not significantly differ and by 20 years of follow-up reached 76 %. A high level of patency of the operated segment was also provided by a large percentage of preserved limbs (80 % after 20 years). A study of the quality of life showed that, despite the persistence of intermittent claudication at the level of 400–800 meters, the vast majority of patients were satisfied with their life. Suppurations in the transplant area and the formation of false aneurysms in the area of anastomoses were found only in the group of aorto-femoral bypass grafts.Conclusion. Open reconstructive operations on the aorto-femoral segment, such as loop endarterectomy and aorto-femoral bypass with adequate postoperative medical examination have good long-term results of survival, patency of the reconstructed segment, percentage of saved limbs and quality of life of patients. Complications in the form of suppuration in the transplant area and the formation of false aneurysms occur only after bypass.