Background: The authors assesed the patenty of proximal anastomosis of aorto-bifemoral graft and analyzed early and late complications in patients with high occlusion of abdominal aorta.
Material and methods: The report presents 35 patients with symptoms of Leriche’s syndrome related to high infrarenal occlusion of the abdominal aorta. The research group consisted of 26 men (74%) and 9 women (26%). In 33 patients (94.3%), primary reconstruction with an aortobifemoral bypass was performed following an earlier aortic segment thrombectomy; 2 patients (5.7%) underwent a secondary bypass as a result of occlusion of the aorta and the previously inserted bypass.
Results: 5 patients (14.2%) died postoperatively, all due to myocardial infarction. In the remaining patients, a follow-up was performed in period 12-37 months after the operation. The following were examined: abdominal aorta width above and at the thrombectomy site, length of the anastomosis, the presence of stenosis in the renal arteries and in the superior mesentric artery, bypass patency, the presence of prosstenosis at the aortic anastomosis. Patency of the anastomosis was noticed in all patients; aortic dilatation at the site of anastomosis was observed in 13 cases (37%) and ranged from 6.5% to 87%. No correlation was shown between the degree of dilatation and time from operation. In 7 cases (20%), anastomosis narrowing was observed in the outflow angle. The distance between the anastomosis and renal arteries was 8 to 19 mm (mean 12 mm). Stenosis of the superior mesentric artery was seen in 6 patients (17%), whilst unilateral renal arteriostenosis was observed in 5 (14%).
Conclusions: The aortic thrombectomy in case of its subrenal occlusion is a procedure which makes possible to perform an anastomosis without clamping the renal arteries. Unfortunatelly such strategy may lead to aortic dilatation in the anastomosis line. However there is no relationship between dilatation extent and the time from the procedure.