Aortofemoral graft for multilevel occlusive disease. Predictors of success and need for distal bypass
D. C. Brewster, B. A. Perler, J. G. Robison and R. C. Darling
Results of aortofemoral reconstruction of 181 consecutive patients with
multilevel occlusive disease were reviewed and correlated with possible
predictors of outcome. Overall, 74% of patients attained satisfactory
relief of ischemic symptoms with proximal operation alone. Forty-six
patients (26%) had an unsatisfactory result, 31 (17%) of whom underwent
distal bypass grafts. Of 42 variables studied, 12 achieved statistical
significance as predictors of outcome, and multivariate analysis identified
five factors an independent indicators. Factors documenting hemodynamically
significant inflow disease were associated most strongly with a good
result. Several noninvasive laboratory variables were found helpful,
particularly in assessing the hemodynamic compensation of distal disease.
While no single variable reliably indicated the definite need for distal
grafting, careful consideration of important factors together with the
clinical situation will aid the surgeon in selection of the small group of
patients best treated by synchronous aortofemoral and femoropopliteal
grafts.
