[Aortofemoral bypass: gold-standard or outdated?]

Abstract

Although aorto-bifemoral bypass procedures have proven efficacy for the treatment of aortoiliac occlusion, complications have led to a preference for less invasive interventions. A precise knowledge of this morbidity is thus necessary to evaluate and compare outcome with alternative techniques. The purpose of this study was to analyze the course of complications observed in a large group of patients who recently underwent aorto-bifemoral bypass performed by the same team. Between 1975 and 1996, 720 patients underwent aorto-bifemoral bypass procedures for occlusion. Indication for surgery was invalidating claudication in 68%, pain at rest in 28% and trophic disorders in 4%. Mean follow-up was 9.6 years. Twenty-three patients were lost to follow-up. One hundred sixty cases of prosthesis complications were recorded (21.3% of patients): ten infections (1.3%), 14 false aortic aneurysms (2%), 40 false femoral aneurysms (5.5%), 82 prosthetic thrombotic events (11.2%), and 14 femoral anastomotic strictures (1.9%). These complications led to death in nine patients (1.2%) and amputation in 23 (3.2%). Analysis of the results show that late mortality attributable to the prosthesis was minimal compare with other causes of death. Numerous complications occur late after prosthetic repair but their impact on mortality and amputations is limited. Aorto-bifemoral bypass is a safe technique that remains the gold standard for evaluation of other revascularization methods.