Strategy of surgical treatment of vascular bypass occlusion

Abstract

Cilj. Analizirati osobitosti bolesnika s okluzijama nakon aortofemoralnih premosnica, način liječenja okluzija nakon aortofemoralnih premosnica i njihovu povezanost s rezultatima liječenja, te utvrditi optimalnu strategiju liječenja okluzija aortofemoralnih premosnica. ----- Ispitanici i metode. Retrospektivna analiza povijesti bolesti bolesnika operiranih od siječnja 1998. do kraja 2012. godine u Zavodu za vaskularnu kirurgiju Klinike za kirurgiju KBC Zagreb. ----- Rezultati. U Zavodu za vaskularnu kirurgiju je od siječnja 1998. do kraja 2012. godine zbog aortoilijačne okluzivne bolesti operirano 286 bolesnika aortobifemoralnom premosnicom. U promatranom razdoblju zabilježene su 54 aortofemoralne okluzije (18,9%) u operiranih bolesnika (40 muškaraca i 14 žena). Prosječna životna dob bolesnika bila je 67,09 godina. Okluzije premosnica su u 18 bolesnika liječene trombektomijom i distalnom premosnicom, u 8 bolesnika femorofemoralnom premosnicom, a u 11 bolesnika trombektomijom i profundoplastikom. U 5 bolesnika je bila učinjena parcijalna resekcija premosnice i rekonstrukcija interpozitumom, u 5 je zamijenjena premosnica, a 3 bolesnika su bila liječena konzervativno. Kod sva 3 bolesnika liječena konzervativno naposlijetku je bila učinjena amputacija. ----- Zaključak. Postotak uspješno spašenih ekstremiteta i nizak mortalitet postupaka govore u prilog opetovanih revaskularizacijskih postupaka u pacijenata s okluzijama aortobifemoralnih premosnica.Aim. To analyze the characteristics of patients with occlusions after aortofemoral bypass grafts as well as surgical treatment options and their correlation with the results. ----- Methods. A retrospective analysis of the medical histories of patients operated from January 1998th to the end of 2012. The analysis was conducted at the Department of Vascular Surgery, University Hospital Center Zagreb. ----- Results. Aortobifemoral bypasses were performed in 286 patients for aortoiliac occlusive disease at the Department of Vascular Surgery from January 1998 to the end of 2012. 54 aortofemoral graft occlusions (18.9%) were noted in treated patients (40 male and 14 female) during the monitored period. Average age of patients was 67.09 years. In 18 patients bypass occlusion was treated with thrombectomy and distal bypass, 8 patients were treated by femorofemoral bypass, and 11 patients with thrombectomy and profundoplasty. Partial graft resection and reconstruction with interpositum was performed in 5 patients. Bypass had to be replaced in 5 patients, and 3 patients were treated conservatively. All 3 patients who were treated conservatively, were subsequently amputated. ----- Conclusion. Limb salvage rate and low mortality of the procedure support the concept of repeated revascularizations in patients with aortobifemoral graft occlusions