AORTOILIAC AND AORTOFEMORAL RECONSTRUCTION OF OBSTRUCTIVE DISEASE

This retrospective study evaluates our strategy to limit prosthetic reconstructions for aortoiliac obstructive disease to the diseased segments in 518 patients. There were 363 (70%) reconstructions without femoral anastomotic sites (FEM-0), 107 (21%) reconstructions with one femoral anastomotic site (FEM-1), and 48 (9%) aortobifemoral reconstructions (FEM-2). The ischemic symptoms and the extent of obstructions were significantly more severe in the FEM-1 and FEM-2 groups than in the FEM-0 group. Early operative results were comparable in all three groups. The difference in outcome became apparent when the long-term results were considered. Long-term follow-up continued for up to 20 years after the operation. Primary and secondary patency rates were significantly higher in the FEM-0 group (9% and 4% recurrent obstructions per 5 years, respectively) than in the FEM-1 and FEM-2 groups (both 14% and 10%, respectively), which was explained by patient selection. Late additional surgery was performed after aortoiliac procedures in most cases for recurrent aortoiliac obstruction and after aortofemoral procedures in most cases for false aneurysms. The risk of late additional operations during long-term follow-up were significantly lower in the FEM-0 group than in the FEM-1 and FEM-2 groups. These results support our strategy to tailor prosthetic reconstructive surgery to the individual status of the aortoiliac arteries.