Extra-Anatomical bypass for arteriosclerosis obliterans

Abstract

Between April, 1981, and May, 1991, 40 patients underwent extra-anatomical bypass surgery for 49 lesions. Thirty-six men and 4 women with a mean age of 68 years (range 48–81) presented with symptoms of aortoiliac occlusive diseases caused by atherosclerosis. Patients were followed up for 44 months (range 1 to 121 months) after surgery. The operative mortality rate was 2.5% (1/40) and there were 4 late deaths. Hypertension, cardiac disease (history of ischemic heart disease and abnormal ECG), cerebrovascular disturbance, and diabetes mellitus were common concomitant preoperative diseases. Forty-nine percent of the limbs (24/49) were classified as Fontaine's class II, 32.7% (16/49) as class III, and the remaining 18.4% (9/49) as class IV.

Surgical procedures were axillofemoral bypasses on 53.1% of the lesions (26/49) and femorofemoral bypasses on the other 46.9% (23/49). Graft materials consisted of expanded polytetrafluoroethylene (EPTFE) (31/49), Dacron (13/49), and modified human umbilical veins (5/49).

The ten-year cumulative patency rate was 95% in the femorofemoral bypass group and 88% in the axillofemoral bypass group.

The anticoagulant (coumarin derivatives) was given at the first postoperative day, and it was continued as long as possible. No complications were recognized regarding this therapy. The value of the thrombo test was maintained between 20% and 40% during the follow-up period.

The extra-anatomical bypass grafting was considered to be a beneficial alternative surgery to anatomical bypass in elderly and high-risk patients. Postoperative anticoagulant therapy may contribute to the patency of grafts.