Chronic infrarenal aortic occlusion: predictors of surgical outcome in patients undergoing aortobifemoral bypass reconstruction.

AIM: Chronic infrarenal aortic occlusion is relatively infrequent. Aortobifemoral bypass has been the traditional treatment. The aim of this study is to evaluate the prognostic factors related to long-term survival and patency rates of chronic infrarenal aortic occlusion after aortobifemoral bypass.

METHODS: From January 1984 to December 2004, we performed consecutively 278 aortobifemoral for aortoiliac occlusive disease. Of these, 67 (24%) patients, 62 men (92.5%), presented with ischemia due to aortic occlusion. The log-Rank test was used to determine predictors of long-term survival and graft patency in a univariate analysis. With a model of proportional-hazards Cox regression the independent prognostic factors of long-term survival were determined.

RESULTS: The postoperative mortality was 8.9%. The estimated cumulative long-term survival for aortic occlusion patients was 56% and 38% at 10 and 20 years, respectively. The estimated cumulative primary patency was 79% at 10 years and 40% at 20 years. The 20-year limb survival rate was 86%. There was no statistical difference in long-term survival and graft patency between TASCIC-D and IRAO. Previous coronary disease (P=0.008) and postoperative complications (P=0.017) significantly decreased the survival of patients. Both variables retained significance on multivariable analysis. The presence of chronic renal failure significantly decreased the patency of the aortobifemoral bypass (P=0.013).

CONCLUSION: Aortobifemoral bypass for chronic infrarenal aortic occlusion has an excellent primary patency rate with reasonable morbi-mortality. The presence of concomitant coronary disease and postoperative complications are prognostic factors of long-term survival.