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KMID : 0357019960120020176
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Journal of the Korean Vascular Surgery Society
1996 Volume.12 No. 2 p.176 ~ p.180
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Early Outcoming of Simultaneous Inflow and Outflow Bypass for Multilevel Arterial Occlusive Disease with Ischemic Rest Pain
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Abstract
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In numerous studies of MLAOD(multilevel arterial occlusive disease), no single predictive factor was found reliable to determine who would benefit from synchronous inflow and outflow procedure. However in the presence of limb-threatening
ischemia,
synchronous procedures provided equal or superior results compared to inflow procedures alone. With this background, we performed 25 consecutive synchronous procedures in 21 male and 4 female patients with MLAOD and did a retrospective analysis
based on
①return of pulse②relief of pain③ABI at rest④Color duplex analysis of graft patency. The main criteria for the procedure was angiographic evidence of multilevel disease with clinical symptoms of ischemia at rest, i.e., Grade Ⅱas described by
the ad
hoc committee on reporting standards. The mean follow up period was 8 month(1-16month). Inflow procedures included aortofemoral bypass (most common), iliac endarterectomy(1 case), and femorofemoral bypass(2 case).
Outflow procedures were femoro-popliteal bypass above or below the knee with saphenous vein as the preferred conduit. The average operating time was 3hours and 45 minute. There was one 30 day mortality in a 76yrs old male who developed a right
'trash
can' and a right 'trash foot' followed by renal failure and subsequent sepsis.
The remaining 24 patients showed improvement in all 4 parameters studied with patency of grafts by serial duplex scanning. In patients with ischemic rest pain and threatened bypass gave satisfactory results. A two team approach in surgery is
recommended
to avoid prolonging operative time. Futher long term follow-up is necessary to determine the durability of these procedures.
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KEYWORD
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