Abdominal Aortic Aneurysms and Associated Peripheral Occlusive Disease

Abstract

During the past 12 years (1970-1982), one hundred and twenty patients were electively operated by the senior author for abdominal aortic aneurysm (AAA) at the Vascular Surgery Department of the University of Padua. Only in about 50% of cases, the lesion was revealed by the presence of a palpable pulsating mass or a calcium line on the X-ray film, especially in the lateral projection. In the remain ing cases, the diagnosis of AAA was made in patients observed for concomitant occlusive disease of the legs or the mass was casually found during laparotomy for other reasons. In 66 patients, the translumbar aortography revealed occlusive disease of the legs with lesions of the iliac axis in 43 cases (bilaterally in 26) and of the femoropopliteal axis in 33 (bilaterally in 19). The tibioperoneal axis was involved in 2 cases. Associate carotid or coronary lesions were surgically treated in separate operative sessions. For technical reasons, the proximal control of the abdominal aorta required section of the left renal vein in 4 cases, section of the inferior mesenteric vein in 10 cases and bilateral revascularization of the renal arteries in 2 cases. In addition, the patients were subdivided 1) according to the means by which intestinal blood flow was guaranteed: adequate blood flow was always guaranteed at least in one of the hypogastric arteries by revascularization of the iliac bifurcation, backflow or reimplantation, or as a last resort reimplanta tion of the inferior mesenteric artery; 2) according to whether or not the con comitant occlusive disease of the legs is corrected: whereas lesions of the iliac axis were routinely corrected either for technical reasons or because of outflow, correction of the second complete occlusion, never routinely performed in pa tients with peripheral occlusive disease, was only necessary in 11.5% of cases; 3) according to the performance of eight aorto-renal bypasses and one transaortic renal artery endarterectomy either for concomitant renovascular hypertension or almost occlusive stenosis of the renal arteries. Early operative mortality was 4.1%. Follow-up (from 6 months to 12 years) information regarding survival was obtained in 87 patients.