Aortofemoral Graft for Multilevel Occlusive Disease

Brewster, David C.; Perler, Bruce A.; Robison, Jacob G.; Darling, R. Clement

doi:10.1001/archsurg.1982.01380360065010

Cited by 92 publications

(2 citation statements)

References 22 publications

(6 reference statements)

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“…*,2 When compared to patients with single level disease, patients with multilevel disease (MLD) are older, predominantly male, and more likely to have diabetes, hypertension, and associated symptomatic atherosclerotic disease in the cerebral, coronary, and visceral arteries. 3 Traditional surgical therapy for patients with MLD has consisted of restoration of inflow to the common femoral or deep femoral arteries as the initial procedureY -n Failure to relieve ischemic symptoms because of persistent distal arterial obstructive disease requires a second operation for distal bypass within days to months in a significant number of patients (reported range, 10% to 56%), depending on the pattern and severity of atherosclerotic involvement of the femoral and popliteal arteries, a'6,9,n14 Despite these discouraging results after the repair of aortoiliac lesions alone, the straightforward approach of performing simultaneous multilevel revascularization procedures has been used infrequently, based on both a perception of greater morbidity and mortality rates associated with the more extensive procedures, as well as the perceived inability to reliably identify before surgery those patients who actually require multilevel revascularization for symptomatic relief. ~s Nevertheless, several groups have reported their resuits with simultaneous multilevel revascularization in selected patients with MLD.…”

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confidence: 99%

Simultaneous operative repair of multilevel lower extremity occlusive disease

Dalman¹,

Taylor²,

Moneta³

et al. 1991

Journal of Vascular Surgery

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Sixty-two patients (39 men (63%), 23 women (27%), mean age 68 years) with multilevel lower extremity arterial occlusive disease underwent simultaneous inflow and outflow operative arterial repair consisting of aortofemoral bypass in 22 (35%), axillofemoral bypass in 17 (28%), femorofemoral bypass in 15 (24%), iliac endarterectomy in 7 (11%), and unilateral aortoiliac bypass in 1 (2%), combined with 69 outflow procedures (unilateral in 55 patients, 89%), including above-knee femoropopliteal in 12 (17%), below-knee femoropopliteal in 35 (51%), femoroinfrapopliteal in 20 (29%), popliteal tibial in 1 (1%), and femoropedal bypass in 1 (1%). Multiple criteria were used to identify patients with multilevel disease likely to benefit from multilevel procedures. The operations were performed by two operating teams in a median time of 240 minutes. Prosthetic grafts were used for eight (13%) distal bypasses, the remainder were autogenous vein. There was one operative death (1.8%). The mortality rate, morbidity rate, and operative time were not significantly different from a group of patients who underwent concurrent, isolated inflow operations (aortofemoral, axillobifemoral, femorofemoral bypass or iliac endarterectomy). Mean follow-up was 14.9 months (range, 0 to 120). The life-table primary patency for the inflow procedures was 92.6% at 24 months, the outflow was 94.9% at 24 months. Cumulative limb salvage was 90.9% at 48-month follow-up. All patients with claudication were relieved of their symptoms. We conclude that complete correction of multilevel disease can be accomplished with operative time, morbidity rate, and patency equal to that of single level repair. Multilevel procedures provide complete relief of symptoms in a higher percentage of patients than has been reported after single level repair.

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confidence: 99%

Simultaneous operative repair of multilevel lower extremity occlusive disease

Dalman¹,

Taylor²,

Moneta³

et al. 1991

Journal of Vascular Surgery

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“…[14][15][16][17] Surgical correction of several diseased segments is not widely used but promises the best results. [17][18][19][20][21][22][23] In recent studies, combining percutaneous transluminal angioplasty (PTA) of the iliac segment with surgical correction of femoropopliteal occlusions promises good results [24][25][26][27] as well as combining inflow procedures with sympathectomy. 28 Aggressive surgical treatment of failed grafts significantly improved the results of treatment, particularly the secondary graft patency rates.…”

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confidence: 99%

Simultaneous Versus Two–Stage Multisegmental Reconstruction for Critical Lower Limb Ischemia

Zukauskas

Ulevicius

1995

Ann Saudi Med

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Treatment of critical limb ischemia (CLI) remains one of the most demanding problems of vascular surgery, especially when it is due to multisegmental occlusive arterial disease. Three main options of treatment are accepted: inflow procedure alone, simultaneous inflow and outflow reconstructions, or two-stage surgery. To compare the results of the latter two was the aim of this study. During a six year period from 1987 to 1992, 1953 aortofemoral reconstructions were performed. In 245 cases (12.5%), sequential aortofemorodistal (popliteal or tibial) procedures were necessary for successful treatment of CLI -Grade III and IV Fountain. In 161 cases, twosegment reconstruction was performed in one stage (Group A), and in 84 cases (Group B), two separate operations were done -outflow procedure followed after the inflow surgery. Results in perioperative and remote postoperative periods were analyzed regarding limb salvage and graft patency rates using a life table method. Perioperative mortality was 3% in Group A and 6% in Group B. The limb salvage rate was 95.6% at one year and 90.4% at five(A), and 88.8% and 80% (B) respectively. Primary overall graft patency rate was 91.4% at one year and 65.5% at five (A) and 84.9% and 59.4% (B) respectively. Secondary graft patency was 92.2% at one year and 81.8% at five (A) and 86.1% and 65.9% (B

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