Surgical Treatment of Aortoiliac Occlusive Disease with Concomitant Superficial Femoral Artery Occlusion

Introduction: Aortofemoral bypass is a standard method for the surgical treatment of aortoiliac occlusive disease. Most of the patients with aortoiliac occlusive disease have multisegment arterial occlusions extending to the popliteal or distal arterial system. In this research early and long term results of aortobifemoral bypass and aortobifemo-ral bypass with combined femoropopliteal bypass were assessed.

Patients and Methods: From March 2002 to October 2011, 833 patients underwent bypass procedures for aortoiliac occlusive disease with concomitant superficial femoral artery occlusion. The patients and surgical procedures were studied prospectively. The patients were divided into 2 groups. Group I (n: 632) consisted of patients who only recevied aortobifemoral bypass. Group II (n: 201) comprised of patients in whom aortobifemoral bypass was combined with femoro-popliteal bypass.

Results: In the early (30 days) and late (42 months) follow up periods, the rate of amputation (8 patients in Group I vs. 16 patients in Group II in the early period; p < 0.05 and 8 patients in Group I vs. 11patients in Group II in the late follow-up; p < 0.05) and mortality (2 patients in Group I and 5 patients in Group II in the early period and 8 patients in Group I vs. 11 patients in Group II in the late follow-up; p < 0.05) were higher in Group II. Moreover, graft patency (0.4% thrombosis rate in Group I vs. 5.4% thrombosis rate in Group II in the long run; p < 0.05), freedom from symptoms (claudication, rest pain and necrosis, 3 patients vs. 9 patients, 9 patients vs. 27 patients and 8 patients vs. 17 patients in Group I and Group II, respectively in the longterm follow-up; p < 0.05) and consequences (mortality, amputation, graft infection and graft extraction rates in the longterm, all p < 0.05) were significantly lower in Group II. Conclusion: Aortobifemoral bypass procedure is an efficient, safe and durable technique for the surgical management of aortoiliac occlusive disease (AIOD) combined with superficial femoral artery occlusion. In this circumstance profunda femoris artery plays the major role for the perfusion of limb.