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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2001 Giugno;42(3):381-7

VASCULAR SECTION 

 ORIGINAL ARTICLES

Comparison of femorofemoral and aortofemoral bypass for aortoiliac occlusive disease

Mingoli A., Sapienza P., Feldhaus R. J., Di Marzo L., Burchi C., Cavallaro A.

From the Depart­ment of Sur­gery Creighton Uni­ver­sity, ­Omaha, NE, USA and *Depart­ment of Sur­gery ''­Pietro Val­doni'' Uni­ver­sity of ­Rome ''La ­Sapienza'', ­Rome, ­Italy

Back­ground. ­Role and ­results of fem­o­rof­e­moral ­bypass ­grafting, usu­ally ­reserved to ­high-­risk ­patients ­affected ­with uni­lat­eral ­iliac ­artery occlu­sion, are ­still ­debated.
­Methods. Experi­mental ­design: ret­ro­spec­tive clin­ical ­study. Set­tings: Uni­ver­sity Hos­pital. ­Patients: sev­enty-six ­high-­risk ­patients (­group 1) who under­went a pri­mary ­expanded poly­tet­ra­flu­o­roe­thy­lene (­ePTFE) exter­nally sup­ported fem­o­rof­e­moral ­bypass ­graft ­were ret­ro­spec­tively com­pared to two addi­tional ­groups of ­patients ­selected ­from the ­entire ­series of ­patients who under­went an aor­to­bif­e­moral ­bypass ­graft. ­Patients of ­group 2 (n=80) ­were ran­domly ­chosen to deter­mine dif­fer­ences in ­risk fac­tors, asso­ciated dis­eases, pre­vious abdom­inal oper­a­tions, oper­a­tive indi­ca­tions, pre­op­er­a­tive find­ings and out­come. ­Patients of ­group 3 (n=50) ­were ­matched for sex, ­risk fac­tors, asso­ciated dis­eases, pre­vious abdom­inal oper­a­tions, oper­a­tive indi­ca­tions and pre­op­er­a­tive find­ings ­with ­those of ­group 1 to ­assess the impor­tance of the ­type of oper­a­tion in deter­mining the out­come of the pro­ce­dure.
­Results. Post­op­er­a­tive mor­tality (6, 4 and 6%, respec­tively), 5-­year pri­mary and sec­on­dary ­patency (71, 80, 83% and 80, 87, 87%, respec­tively) and ­limb sal­vage ­rates (78, 87 and 87%, respec­tively) ­were sim­ilar ­among the ­groups (p=NS, p=NS, p=NS, respec­tively). ­Five-­year sur­vival ­rate of ­group 2 was sig­nif­i­cantly ­better ­than ­that of ­group 1 and 3 (p<0.04 and p<0.04, respec­tively).
Con­clu­sions. Pri­mary ­ePTFE exter­nally sup­ported fem­o­rof­e­moral ­bypass ­graft in ­high-­risk ­patients is ­safe and pro­duces ­long-­term ­results sim­ilar to aor­tof­e­moral recon­struc­tion.

lingua: Inglese


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