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Article
December 1982

Aortofemoral Graft for Multilevel Occlusive DiseasePredictors of Success and Need for Distal Bypass

Author Affiliations

From the General Surgical Services, Massachusetts General Hospital, and Department of Surgery, Harvard Medical School, Boston.

Arch Surg. 1982;117(12):1593-1600. doi:10.1001/archsurg.1982.01380360065010
Abstract

• Results of aortofemoral reconstruction of 181 consecutive patients with multilevel occlusive disease were reviewed and correlated with possible predictors of outcome. Overall, 74% of patients attained satisfactory relief of ischemic symptoms with proximal operation alone. Forty-six patients (26%) had an unsatisfactory result, 31 (17%) of whom underwent distal bypass grafts. Of 42 variables studied, 12 achieved statistical significance as predictors of outcome, and multivariate analysis identified five factors as independent indicators. Factors documenting hemodynamically significant inflow disease were associated most strongly with a good result. Several noninvasive laboratory variables were found helpful, particularly in assessing the hemodynamic compensation of distal disease. While no single variable reliably indicated the definite need for distal grafting, careful consideration of important factors together with the clinical situation will aid the surgeon in selection of the small group of patients best treated by synchronous aortofemoral and femoropopliteal grafts.

(Arch Surg 1982;117:1593-1600)

References
1.
Brewster DC, Darling RC:  Optimal methods of aortoiliac reconstruction . Surgery 1978;84:739-748.
2.
Crawford ES, Bomberger RA, Glaeser DH, et al:  Aortoiliac occlusive disease: Factors influencing survival and function following reconstructive operation over a 25-year period . Surgery 1981;90:1055-1067.
3.
Moore WS, Cafferata HT, Hall AD, et al:  In defense of grafts across the inguinal ligament: An evaluation of early and late results of aortofemoral bypass grafts . Ann Surg 1968;168:207-214.Article
4.
Imparato AM, Samoudos G, Epstein HY, et al:  Results in 96 aortoiliac reconstructive procedures: Preoperative angiographic and functional classifications used as prognostic guides . Surgery 1970;68:610-616.
5.
Perdue GD, Long WD, Smith RB III:  Perspective concerning aortofemoral arterial reconstruction . Ann Surg 1971;173:940-944.Article
6.
Royster TS, Lynn R, Mulcare RJ:  Combined aortoiliac and femoropopliteal occlusive disease . Surg Gynecol Obstet 1976;143:949-952.
7.
Edwards WH, Wright RS:  A technique for combined aorto-femoral-popliteal arterial reconstruction . Ann Surg 1973;179:572-578.Article
8.
Malone JM, Moore WS, Goldstone J:  The natural history of bilateral aortofemoral bypass grafts for ischemia of the lower extremities . Arch Surg 1975;110:1300-1306.Article
9.
Jones AF, Kempczinski RF:  Aortofemoral bypass grafting: A reappraisal . Arch Surg 1981;116:301-305.Article
10.
Hill DA, McGrath MA, Lord RSA, et al:  The effect of superficial femoral artery occlusion on the outcome of aortofemoral bypass for intermittent claudication . Surgery 1980;87:133-136.
11.
Martinez BD, Hertzer NR, Beven EG:  Influence of distal arterial occlusive disease on prognosis following aortobifemoral bypass . Surgery 1980;88:795-805.
12.
Nevelsteen A, Suy R, Daenen W, et al:  Aortofemoral grafting: Factors influencing late results . Surgery 1980;88:642-653.
13.
Sumner DS, Strandness DE Jr:  Aortoiliac reconstruction in patients with combined iliac and superficial femoral arterial occlusion . Surgery 1978;84:348-355.
14.
O'Donnell TF Jr, Lahey SJ, Kelly JJ, et al:  A prospective study of Doppler pressures and segmental plethysmography before and following aortofemoral bypass . Surgery 1979;86:120-128.
15.
Bone GE, Hayes AC, Slaymaker EE, et al:  Value of segmental limb blood pressures in predicting results of aortofemoral bypass . Am J Surg 1976;132:733-738.Article
16.
Garrett WV, Slaymaker EE, Heintz SE, et al:  Intraoperative prediction of symptomatic results of aortofemoral bypass from changes in ankle pressure index . Surgery 1977;82:504-509.
17.
Mozersky DJ, Sumner DS, Strandness DE:  Long-term results of reconstructive aortoiliac surgery . Am J Surg 1972;123:503-509.Article
18.
Galland RB, Hill DA, Gustave R, et al:  The functional results of aortoiliac reconstruction . Br J Surg 1980;67:344-346.Article
19.
Baird RJ, Feldman P, Miles JT, et al:  Subsequent downstream repair after aorta-iliac and aorta-femoral bypass operations . Surgery 1977;82: 785-793.
20.
Mulcare RJ, Royster TS, Lynn RA, et al:  Long-term results of operative therapy for aortoiliac disease . Arch Surg 1978;113:601-604.Article
21.
Benson RJ, Whelan TJ, Cohen A, et al:  Combined aorto-iliac and femoropopliteal occlusive disease: Limitations of total aortofemoropopliteal bypass . Ann Surg 1966;163:121-130.Article
22.
Satiani B, Liapis CD, Evans WE:  Aortofemoral bypass for severe limb ischemia: Long-term survival and limb salvage . Am J Surg 1981; 141:252-256.Article
23.
Bernstein EF, Rhodes GA, Stuart SH, et al:  Toe pulse reappearance time in prediction of aortofemoral bypass success . Ann Surg 1981;193: 201-205.Article
24.
Boren CH, Towne JB, Bernhard VM, et al:  Profundapopliteal collateral index: A guide to successful profundaplasty . Arch Surg 1980;115: 1366-1372.Article
25.
Collins GJ Jr, Rich NM, Anderson CA, et al:  Staged aortofemoropopliteal revascularization . Arch Surg 1978;113:149-152.Article
26.
O'Hara PJ, Brewster DC, Darling RC, et al:  The value of intraoperative monitoring using the pulse volume recorder during peripheral vascular reconstructive operations . Surg Gynecol Obstet 1981;152:275-281.
27.
Satiani B, Hayes JP, Evans WE:  Prediction of distal reconstruction following aortofemoral bypass for limb salvage . Surg Gynecol Obstet 1980;151:500-502.
28.
Kozloff L, Collins GJ Jr, Rich NM, et al:  Fallibility of postoperative Doppler ankle pressures in determining the adequacy of proximal arterial revascularization . Am J Surg 1980;139:326-329.Article
29.
Brenner BJ, Raines JK, Darling RC, et al:  Measurement of systolic femoral artery pressure during reactive hyperemia: An estimate of aortoiliac disease . Circulation 1974;49/50( (suppl 2) ):259-267.Article
30.
Brewster DC, Waltman AC, O'Hara PJ, et al:  Femoral artery pressure measurement during aortography . Circulation 1979;60( (suppl 1) ): 120-124.Article
31.
Darling RC, Raines JK, Brener BJ, et al:  Quantitative segmental pulse volume recorder: A clinical tool . Surgery 1972;72:873-887.
32.
Raines JK, Darling RC, Buth J, et al:  Vascular laboratory criteria for the management of peripheral vascular disease of the lower extremities . Surgery 1976;79:21-29.
33.
Darling RC, Brewster DC, Hallet JW Jr, et al:  Aorto-iliac reconstruction . Surg Clin North Am 1979;59:565-579.
34.
O'Donnell TF Jr, McBride KA, Callow AD, et al:  Management of combined segment disease . Am J Surg 1981;141:452-459.Article
35.
Dardik H, Ibrahim IM, Jarrah M, et al:  Synchronous aortofemoral or iliofemoral bypass with revascularization of the lower extremity . Surg Gynecol Obstet 1979;149:676-680.
36.
Strandness DE Jr:  Functional results after revascularization of the profunda femoris artery . Am J Surg 1970;119:240-245.Article
37.
Morris GC Jr, Edwards E, Cooley DA, et al:  Surgical importance of the profunda femoris artery: Analysis of 102 cases with combined aortoiliac and femoropopliteal occlusive disease treated by revascularization of deep femoral artery . Arch Surg 1961;82:32-37.Article
38.
Bernhard VM, Ray LI, Militello JP:  The role of angioplasty of the profunda femoris artery in revascularization of the ischemic limb . Surg Gynecol Obstet 1976;142:840-844.
39.
Martin P, Frawley JE, Barabas AP, et al:  On the surgery of atherosclerosis of the profunda femoris artery . Surgery 1972;71:182-189.
40.
Heyden B, Vollmar J, Voss EU:  Principles of operation for combined aortoiliac and femoropopliteal occlusive lesions . Surg Gynecol Obstet 1980; 151:519-524.
41.
Fogarty TJ, Chin A, Shoor PM, et al:  Adjunctive intraoperative arterial dilation: Simplified instrumentation technique . Arch Surg 1981; 116:1391-1398.Article
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