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October 1986

Aortic Reconstruction vs Extra-anatomic Bypass and Angioplasty: Thoughts on Evolving a Protocol for Selection

Author Affiliations

From the Department of Surgery, University of South Carolina School of Medicine, Columbia.

Arch Surg. 1986;121(10):1166-1171. doi:10.1001/archsurg.1986.01400100074015

• One hundred forty-eight patients were evaluated for inflow revascularization and stratified by age, vascular anatomy, medical history, and cardiac functional class into aortic reconstruction (AR), extra-anatomic bypass (EAB), or iliac angioplasty based on a protocol that restricted AR to good-risk patients and liberalized indications for EAB. Fifty-five patients underwent AR with a 1.8% mortality, 1.8% myocardial infarction and 12% morbidity, and cumulative life-table patency of 94% at two years; 69 patients underwent EAB with no mortality and negligible morbidity; cumulative life-table patency was 93% at two years for crossover femoral and 83% at two years for axillofemoral grafts. Operative selection based on a protocol restricting AR to better-risk patients and liberalizing use of EAB may decrease overall patient mortality and morbidity without jeopardizing limb preservation.

(Arch Surg 1986;121:1166-1171)

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