Surgical Management Of Chronic Aortoiliac Arterial Occlusive Disease In The Elderly

Objective To discuss the surgical management of chronic AIOD(aortoiliac occlusive disease) and clinical outcomes followed by extra-anatomy bypasses in the elderly. Methods From January 2005 to December 2008,33 elderly patients(age ranged from 70 to 87 years,mean 75.2 years) with aortoiliac occlusive disease were retrospectively analyzed,including 26 males and 7 females.According to Fontaine classification,there were 5 cases(7 limbs) with phaseⅡb,22 cases(26 limbs) with phaseⅢ,6 cases(6 limbs) with phaseⅣ.Concurrent diseases included hypertension, diabetes mellitus,coronary artery disease,chronic obstructive pulmonary disease,chronic renal insufficiency,et al.Results 33 cases(39 limbs) were treated with a variety of bypass,including axillobifemoral bypass(6 cases/12 limbs),femorofemoral bypass(7 cases/7 limbs), axillofemoral bypass(20 cases/20 limbs).Among them 17 cases(17 limbs) were treated with femoral profundoplasty/ iliac stent placement based on extra-anatomy bypass.Intermittent claudication(5 cases) and rest pain(22 cases) improved while ulcers(6 cases) healed after operations.Respectively,the mean ABI was improved from 0.29±0.11 to 0.66±0.13.39 limbs(100%) were salvaged and no surgical death ocurred during 30 days after operations.Postoperative complication rate was 9.1%.Patients were followed for a median of 12 months(range,1 month to 28 months),primary patency of graft was 87.9%,secondary patency was 90.9%,limb salvage was 90.9%.During the time of follow-up,one cases died of MI(myocardial infarction) and another died of malignant tumor(gastric cancer).Conclusion The elderly patients with AIOD are poor candidates to operation,there is usually a high complication incidence rate among them.Therefore we emphasize that a safe and simple surgical management should be considered first.Using a proper surgical management can salvage limbs and reduce complications effectively.