Role Of Extra-anatomy Bypass In The Treatment Of Aorta-iliac Occlusive Disease

Objective: To evaluate the clinical effect of axillary-femoral/popliteal arterialbypass in the treatment of aorta-iliac occlusive disease, and the indications and technicalcharacters are also discussed.Methods: We retrospectively analysed35patients suffered from aorta-iliacocclusive disease from January1st2005to January1st2013in our department. Clinicalfeatures include claudication in5, resting pain11and ulcer/gangrene19patients,respectively. Diseases for occlusion include arteriosclerosis obliterans in29cases,thrombosis5cases, dissection1case, respectively. Nineteen of them were treated byaxillo-bifemoral/popliteal bypass, and the others were treated by axillo-unifemoral/popliteal bypass. Clinical data were analysed in two groups (axillo-bifemoral/poplitealbypass group and axillo-unifemoral/popliteal bypass group) with a media follow-uptime rang from15months to62months. We summarized preoperative condition,perioperative management, indications, contraindications and operative method of thepatients. The postoperative complications and survival conditions were also observed.Results: Case number35, with a mean age (range:36-85years),27male(77.1%)and8female(22.9%). The age, gender, smoking history, symptoms and complications ofthe patients were similar to those in published reports. Axillo-bifemoral/poplitealbypass was performed in19and axillo-unifemoral/popliteal bypass16cases,respectively. All operations were successful. Complications of axillo-bifemoral/ popliteal bypass group were2cases(1mguinal lymph leakage of incision,1vascularprosthesis occlusion). And the complications of axillo-unifemoral/popliteal bypassgroup were4cases (1mild renal insufficiency,1wound healing bad,2vascularprosthesis occlusion). No death in all patients. The re-intervention rate ofaxillo-bifemoral/popliteal group were0.05%(1/19), and18.75%(3/16) inaxillo-unifemoral/popliteal group.Conclusions:1. Axillary-femoral/popliteal arterial bypass has merits like operationtechnique simple, less invasion, patients easy to tolerance and definite therapeuticeffects, and this is one of the effect methods for the treatment of aorta-iliac occlusivedisease.2. Axillo-bifemoral/popliteal bypass can increase blood flow ofvascularprosthesis, thus can enhance the patency rate of it. However, some literatures reportedthere was no difference of the patency rate between axillo-bifemoral/popliteal bypassand axilo-unifemoral/popliteal bypass. Yet the patency rate of two surgical methodsshould be further observed because of limited case number and follow-up time.