Long-Term Survival after Reconstructive Operation in Patients with Arteriosclerosis Obliterans

Abstract

Postoperative long-term survival for arteriosclerosis obliterans (ASO) of lower extremities was examined in 218 patients who underwent reconstructive surgery from 1973 to 1992. The causes of late deaths and their relation to the arteriosclerosis of various organs were also examined. Patients were divided into three groups according to the type of operation: aortoiliac/femoral (AIF), axillo/femorofemoral (AxF), and femoropopliteal bypass (FP) and were then divided into two subgroups according to the times of operation: "former decade" (subgroup F, 1973-1982, AIF 43, AxF 31, FP 10) and "latter decade" (subgroup L, 1983-1992, AIF 58, AxF 40, FP 36). The mean ages at operation for AIF-F/L were sixty/sixty-three years, and these were significantly younger than sixty-nine/seventy for AxF-F/L and sixty-five/sixty-seven for FP-F/L. There were 74 late-death patients, and of them, 57 (77%) died of arteriosclerosis-related diseases of various organs such as ischemic heart disease. Among these 57 patients, 39 (68%) experienced organ failure as a preop erative complication, whereas in the remaining 18, such failure was not clinically evident prior to operation. The survival rates at five/ten years after operation were 84%/61% in AIF-F, 88%/76% in AIF-L, 49%/20% in AXF-F, 75%/52% in AXF-L, and 73%/73% in FRL. The survival rate at ten years for subgroup L was 66% and was higher as compared with 42% for subgroup F owing in large part to the significant improvement in AXE

In conclusion, for patients with ASO, postoperative life expectancy improved recently, but arteriosclerosis of various organs was still the main cause of late deaths. Lifelong critical care for systemic organs was necessary even in patients in whom such lesions were not yet clinically evident at the time of operation.