Purpose: To evaluate the efficacy of surgical treatment for
multilevel aortoiliac occlusive diseases, we retrospectively analyzed 89
recent cases surgical treatment was used. Methods: From March 1992 to
July 2001, we performed 62 aortobifemoral bypasses and 27 other bypasses as
primary procedures. We analyzed surgical indications, combined diseases,
cardiac risk assessment, type of occlusion, treatment modalities and
cumulative patency rate. Results: In 59 aortobifemoral bypasses, 8
end-to-end and 51 end-to-side proximal anastomoses were performed. Adjuvant
PTA, with or without stent before bypass operation, was performed in 13
cases. Types of occlusions were Rutherford type Ⅰ in 18.0%, type Ⅱ in
20.2% and type Ⅲ in 61.8%, respectively. Associated diseases were
hypertension, diabetes, cerebrovascular accidents, and myocardial infarction
in order of frequency. Mean follow-up duration was 36.4 months. Cumulative
patency rate by life table analysis was 77.5%. Leg or foot amputations were
performed in 13 cases (14.6%) after bypass operations. Two cases of
amputation were performed after 13 simultaneous infrainguinal bypasses, and
in 4 cases after staged infrainguinal bypasses. Operative mortality occured
in 4 cases (4.5%). Conclusion: Aortobifemoral bypass remains one of
the most durable and effective arterial reconstructions, for extensive
aortoiliac occlusive diseases in young patients with low operative risk.
Simultaneous infrainguinal bypass is preferred in patients with poor distal
run-off.
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