Is Aortoprofunda Bypass a Successful Operation for Multilevel Occlusive Disease?

Abstract

During a ten-year period (1976-1986) at the Toronto General Hospital, 121 patients underwent aortoiliac reconstruction with one or both of the distal anas tomoses to the level of the profunda femoris artery. The cumulative five-year graft patency rate in 117 patients surviving the operation was 97±1.3%, the cumulative five-year clinical success rate (patent graft and clinical improve ment) was 76±5.2%, and the cumulative five-year hemodynamic success rate (patent graft and improved ankle/brachial pressure ratio) was 67±5.9%. There was no significant difference in cumulative clinical success when stratified for sex, preoperative grade (claudication vs limb salvage), proximal anastomosis (end-to-end vs end-to-side), or length of profundoplasty. The authors' experi ence indicates that aortoprofunda bypass is a successful operation for the man agement of multilevel vascular occlusive disease with very few patients requiring subsequent distal revascularization. It is not unusual to observe clini cal improvement despite a relatively small increase in "resting" ankle/brachial index. A gradual decrease in clinical and hemodynamic success can be expected secondary to either anastomotic hyperplasia or progression of distal athero sclerotic disease.