An Evaluation of Operative Approach and Optimal Bypass Graft Flow for Aortoiliac Artery Obstruction / 日本心臓血管外科学会雑誌

ABSTRACT

Arterial reconstructions for iliac artery obstruction (IAO) were performed in 81 patients (70 males and 11 females) with arteriosclerosis obliterans (80) and thromboangiitis obliterans (1) from January 1979 to January 1991. Ages ranged from 36 to 79 with a median age of 63.4. Aortofemoral bypass (AF-B) was performed in 46 cases (including 21 Y graft patients), thromboendarterectomy (TEA) in 11, femoro-femoral cross-over bypass (FF-B) in 26 and axillo-femoral bypass (AXF-B) in 2. No patients in the AF-B, TEA or AXF-B group showed postoperative early occlusion, while two in the FF-B group had early occlusion. The bypass flow measured intra-operatively using an electro-magnetic flowmeter was 50-1, 100 (average 382) ml/min in the AF-B, 190-500 (331) ml/min in the TEA, 90-650 (219) ml/min in the FF-B, and 200ml/min in the AXF-B group. Two patients died; one from ischemic colitis and the other from myonephropathic metabolic syndrome. The long-term cumulative patency rates at 1, 2 and 5 years were 100, 96, and 96% in the AF-B, 100, 100, and 100% in the TEA, and 90, 84, 63% in the FF-B group, respectively. The two AXF-B cases had good patency one year and three years postoperatively. AF-B should be recommended for aorto-iliac obstruction even in high risk patients as long as severe heart disease is absent, because of the long-term patency rate. An additional bypass to the popliteal region should be performed, if bypass flow to the distal region is low.