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Abstract
The safety and durability of elective reconstructive procedures of the abdominal aorta
and its major branches are universally accepted; however, late complications continue
to threaten limbs and lives of a minority of patients. The strategy of managing such
revascularization failures has received inadequate attention. Between February 1971
and July 1981, 76 patients underwent 83 remedial, transabdominal revascularization
procedures because of failed reconstructions. Group I consisted of 34 patients with
occlusive complications (0% remedial operative mortality rate); group II, 21 patients
with prosthetic sepsis including graft-enteric fistula (14% operative mortality);
group III, 11 patients with aneurysmal degeneration (36% operative mortality); and
group IV, 10 patients with visceral ischemia (0% operative mortality). The remedial
operative mortality rate for the combined groups was 7.9%. Limb preservation was the
rule in group I (91%); however, 29% of limbs at risk m group II ultimately required
major amputation (15% early, 14% late). All patients in group II without an established
graft-enteric fistula were saved; however, three of ten with active hemorrhage died
of the sequelae of hypovolemic shock. Progressive arteriosclerotic morbidity and massive
intraoperative bleeding accounted for the high mortality rate in group III. Favorable
results were obtained in reoperation for recurrent visceral ischemia (renal ischemia
in five, mesenteric ischemia in five). On the basis of this experience, an aggressive
surgical approach seems justified. First, complete bifemoral revascularization performed
at the time of original operation should reduce the need for reoperation. Second,
elective, transabdominal remedial arterial surgery can be done with acceptable morbidity
and mortality rates. Third, graft-enteric erosions and periprosthetic sepsis must
be treated aggressively to avoid life-threatening sepsis and hemorrhage. Finally,
anatomic revascularization can be performed successfully after a suitable period following
removal of an infected retroperitoneal prosthesis.
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Article info
Footnotes
☆Presented at the Sixth Annual Meeting of the Southern Association for Vascular Surgery, Marco Island, Fla., Jan. 29–30, 1982.
Identification
Copyright
© 1983 Published by Elsevier Inc.
