Bifurcated prosthesis in infrarenal aortic position in stenosing lesions. funcional results

Fifty-eight patients operated upon of infrarenal aortic bifurcated grafts for occlusive disease, in a 6-year period, have been followed-up with a minimum interval of 2 years. The patients were in claudication stage in 63% of the cases and in critical limb threat ischemia in 37% Bypass consisted always in a bifurcated knitted dacron graft either pre-coagulated or sealed. Infrarenal aorta has always been the donor axis, whereas distal anastomosis has been performed on both common femoral in 80% of the cases, on at least one external iliac in 20%. In 5% of the cases a femoro-popliteal bypass has been associated to the main procedure. Postoperative mortality was 3.5%. The occlusion of a prosthetic branch in the postoperative period occurred in one case, requiring a major amputation. Seven patients (12%) presented 11 late thrombosis of one prosthetic branch or both on an interval varying from 4 to 62 months. Eight occlusions required reintervention. Only one, lethal, late prosthetic sepsis was recorded. In a mean interval of 54 months, a good or fair functional result was achieved in 93% of the patients. Out of 22 patients specifically questioned upon, 82% returned to their normal work activity, whereas 18% retired but had a fully normal everyday's life. Sexual function was ameliorated or unchanged in 67% of the cases, while it was impaired in 33%. Eighty-seven percent of the followed-up patients did not require any further hospitalisation for atherosclerotic disease, while 13% of them experienced subsequent hospitalisation or reintervention for progression of the disease either at the same or at different arterial sites. Overall good results support an aggressive attitude towards aorto-iliac-femoral grafting for occlusive disease.