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ORIGINAL ARTICLES  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2003 February;44(1):87-93

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Surgical management of chronic total occlusion of abdominal aorta

Mavioglu I. 1, Veli Dogan O. 2, Ozeren M. 2, Dolgun A. 2, Yucel E. 2

1 Department of Thoracic and Cardiovascular Surgery Mersin University School of Medicine, Mersin, Turkey 2 Department of Cardiovascular Surgery S.S.K. Ankara Training Hospital, Ankara, Turkey


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Aim. The sur­gical man­age­ment of the ­totally ­occluded abdom­inal ­aorta is ­highly com­plex and pos­sible com­pli­ca­tions are ­more likely to be ­seen. We ­reviewed our expe­ri­ence to ­make a ­base for ­future endo­lu­minal pro­ce­dures.
­Methods. Sev­enty-one ­patients ­with ­totally ­occluded abdom­inal ­aorta ­were oper­ated ­between 1985 and 1998 in a ­main ­referral hos­pital of the ­social ­security organ­iza­tion and the ­results of vas­cular inter­ven­tions ­were eval­u­ated ret­ro­spec­tively. Jux­ta­renal ­aortic occlu­sion was ­seen in 52% of ­these ­patients. All the ­patients ­were oper­ated ­using the trans­per­it­o­neal ­approach and ade­quate dis­sec­tion to con­trol ­renal ­arteries. Lim­ited throm­bec­tomy ­through infra­renal aor­totomy ­without tran­secting the ­aorta was ­done and con­tinued ­with stan­dard ­aortic ­graft inser­tion ­except for 1 ­patient ­with por­ce­lain ­aorta.
­Results. ­Follow-up was 76.9±41.9 (SD) ­months. Four­teen ­patients had con­cur­rent ­femoro-­distal ­bypass and 2 ­patients had con­cur­rent ­renal ­bypass. Per­i­op­er­a­tive mor­tality was 5.6% and 26.5% of ­patients ­needed a ­second inter­ven­tion ­during ­follow-up. ­Five-, 10- and 13-­year sur­vival and ­freedom ­from sec­on­dary oper­a­tion was as fol­lows: 84%, 56% and 44%, 81%, 54% and 42%. Cumu­la­tive pri­mary and sec­on­dary ­graft paten­cies at 5- and 10-­years ­were 68%, 63% and 92%, 92%, respec­tively.
Con­clu­sion. Sur­gical inter­ven­tion is ben­e­fi­cial for ­patients ­with ­totally ­occluded ­aorta ­even if ­ischemic com­plaints are rel­a­tively ­mild and ­stable. Accept­able mor­tality ­rates and ­long-­term ­results ­form ­a basis for ­future endo­vas­cular inter­ven­tions.

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