Aortic reconstruction vs extra-anatomic bypass and angioplasty. Thoughts on evolving a protocol for selection
T. J. Bunt
One hundred forty-eight patients were evaluated for inflow
revascularization and stratified by age, vascular anatomy, medical history,
and cardiac functional class into aortic reconstruction (AR),
extra-anatomic bypass (EAB), or iliac angioplasty based on a protocol that
restricted AR to good-risk patients and liberalized indications for EAB.
Fifty-five patients underwent AR with a 1.8% mortality, 1.8% myocardial
infarction and 12% morbidity, and cumulative life-table patency of 94% at
two years; 69 patients underwent EAB with no mortality and negligible
morbidity; cumulative life-table patency was 93% at two years for crossover
femoral and 83% at two years for axillofemoral grafts. Operative selection
based on a protocol restricting AR to better-risk patients and liberalizing
use of EAB may decrease overall patient mortality and morbidity without
jeopardizing limb preservation.
