Clinical Outcomes of 5358 Patients Undergoing Direct Open Bypass or Endovascular Treatment for Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis

Indes, Jeffrey; Pfaff, Miles J.; Farrokhyar, Forough; Brown, Hillary A; Hashim, Peter W.; Cheung, Kevin; Sosa, Julie Ann

doi:10.1583/13-4242.1

Cited by 158 publications

(131 citation statements)

References 61 publications

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“…Mortality for open aortobifemoral bypass has been estimated to be around 2.6%. 4 A large single center study of 822 patients reported an even lower mortality of 0.1%. 27 To date no randomized controlled trial has shown a difference in mortality between the two techniques.…”

Section: Discussionmentioning

confidence: 98%

“…Notwithstanding a marked improvement in safety in the last decades, open AIOD surgery is still associated with a high level of morbidity and mortality. 3,4 Inspired by the successes of minimally invasive laparoscopic procedures in abdominal surgery, Dion and colleagues 5,6 performed the first laparoscopically assisted aortobifemoral bypass in 1993 and the first totally laparoscopic procedure in 1995. Laparoscopic aortobifemoral bypass has been performed at the authors' center since 2003.…”

Section: Introductionmentioning

confidence: 99%

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Long-term Results of Totally Laparoscopic Aortobifemoral Bypass

Lecot

Sabbe

Houthoofd

et al. 2016

European Journal of Vascular and Endovascular Surgery

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Long-term Results of Totally Laparoscopic Aortobifemoral Bypass

Lecot

Sabbe

Houthoofd

et al. 2016

European Journal of Vascular and Endovascular Surgery

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“…The absent femoral pulses on clinical examination clinched the diagnosis of vascular origin of paraplegia in this case. Urgent CT-aortogram confirmed the diagnosis and helped in decision making for appropriate management [8]. Management strategies for such patients include anticoagulants, thrombolysis, embolectomy, endovascular techniques and extra-anatomical bypass with varying degrees of success [9].…”

Section: Discussionmentioning

confidence: 99%

Leriche Syndrome: Acute Onset Painful Paraplegia of Vascular Origin with Catastrophic Consequences

Mahendrakar¹

2017

JCDR

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A 59-year-old male patient was admitted to Emergency Room with acute onset of lower backache, bilateral lower limb weakness, intense pain, and paraesthesia with inability to walk for preceding six hours with no history of trauma. He was a reformed smoker with a sedentary life style as a carom player and had dyslipidaemia but was not on any medications. After initial evaluation a Magnetic Resonance Imaging (MRI) of the lumbosacral spine was done which showed no evidence of compressive myelopathy. Shortly afterwards he developed dyspnoea and excruciating bilateral lower limb pain for which he was transferred to our Intensive Care Unit (ICU) for further management. Careful prodding revealed that patient had an unevaluated bilateral intermittent lower limb pain on exertion since last six months. On clinical examination patient had body mass index of 27.68 kg/m 2 . Heart Rate (HR) of 140/minute, non invasive blood pressure of 150/90 mmHg with absent bilateral femoral and distal lower limb pulsations while other pulsations were normal. Patient had a Respiratory Rate (RR) of 34/minute with orthopnoea, bilateral basal crepitations and 95% Oxygen Saturation (SpO 2 ) on four litres oxygen by facemask. Both the lower limbs were cold with motor power of 0/5 at bilateral hip joints and distally with absent deep tendon reflexes but a detailed neurological exam could not be performed. Electrocardiogram showed sinus tachycardia with ST segment depression in inferolateral leads. Bedside two-dimensional echocardiogram showed global hypokinesia with left ventricular ejection fraction of 25% with a normal sized right atria and right ventricle. Routine blood investigations showed mild leucocytosis with a normal haemoglobin, renal and liver function tests. Cardiac biomarkers Creatine Kinase (CK-MB): 29.2 ng/ml. Troponin-I: 1.2 ng/ml, Brain Natriuretic Peptide (BNP): 1230 pg/ml and D-Dimer: 3590 ng/ml were elevated. He was stabilized with non invasive ventilation, antiplatelets, statins, loop diuretics, Low Molecular Weight Heparin (LMWH) and intravenous nitroglycerine. An urgent CT aortogram was done which showed complete occlusion of infra renal aorta, proximal segment of both common iliac arteries and origin of internal mesenteric artery with partial thrombosis of mid-distal segment of both common iliac, external iliac, internal iliac and both common femoral arteries along with bilateral wedge renal and splenic infarct [Table/ Fig-1,2].In view of acute onset atherosclerotic long segment thrombus, surgical intervention was planned. The patient underwent emergency bilateral trans-femoral embolectomy and about 20 cm long thrombus with diffuse atherosclerosis was removed [Table/ Fig-3]. Postoperatively patient was shifted back to ICU and examination showed warm and re-perfused bilateral lower limbs with definite distal pulses but persistent motor and sensory loss. Antiplatelets and LMWH were continued along with Inj. piperacillintazobactum 4.5 gm intravenously in thrice daily dosing. Adequate hydration, urine output was maintained post...

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“…The last measured HbA1c was 8.0%, approximately six years prior to presentation. We suspect that the resolution of his infections, combined with regular endocrinology follow-up, contributed to the drastic decrease in HbA1c [52,53].…”

Section: Glycosylated Hemoglobinmentioning

confidence: 99%

Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition

Blank

Rothstein

Lee

et al. 2017

J Vasc Endovasc Surg

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Context: Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report two cases of aortobifemoral bypass graft malposition through the colon.Case report: Case 1 is a 54 year old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately six months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60 year old male who underwent aorto bifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately ten weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum. Conclusions:Aortic graft infection is usually caused by surgical contamination, and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.

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Clinical Outcomes of 5358 Patients Undergoing Direct Open Bypass or Endovascular Treatment for Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis

Abstract: Although this study was limited by a paucity of randomized control trials, these results demonstrate superior durability for open bypass, although with longer LOS and increased risk for complications and mortality, when compared to the endovascular approach.

Cited by 158 publications

References 61 publications

Long-term Results of Totally Laparoscopic Aortobifemoral Bypass

Long-term Results of Totally Laparoscopic Aortobifemoral Bypass

Leriche Syndrome: Acute Onset Painful Paraplegia of Vascular Origin with Catastrophic Consequences

Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition

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