[Treatment of ischemia in late thrombosis after aorto-iliaco-femoral reconstructions].

Late thrombosis of inserted prosthetic grafts for arterial reconstructive surgery is one of the most frequent late complication. Its incidence is influenced by many factors: hemodynamic conditions, quality of run-in and run-off, technical aspects of the primary repair. Progressive arteriosclerosis in femoral vessels was the cause of graft limb thrombosis in most instances. When graft occlusion does occur, there is, in a majority of patients, an immediate return of ischemia which often is severe and redo-operation is indicated to restore circulation. A new angiogram is mandatory, especially for the recognition of the inflow to the central anastomosis and for the evaluation of the distal run-off. Several surgical techniques are in use for redo-operation (graft thrombectomy with or without graft prolongation, partial or total replacement of the prosthesis, reconstruction by an extra-anatomical by-pass). Very important is the role of the deep femoral artery: in patients with a multi-level occlusive disease a patent deep femoral artery most often provides an effective inflow repair with a combined use of profundaplasty and lumbar sympathectomy. In this report of 188 late thrombosis, in a twenty year experience, at the Department of General and Cardiovascular Surgery, University of Milan, we made a redo-operation in 83% of the cases, according our preference in surgical procedures, to the partial substitution of the prosthesis with large profundaplasty. An associated lumbar sympathectomy was performed in 25% of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)